There were multiple things I learned this week while reading Aronson and Cruikshank. Cruikshank (2003) framed the aging population as a growing market for pharmaceuticals, and it makes sense considering that according to her research older adults make up 35-46% of prescription consumers. I would be interested to know how that has changed in the time since this book was written. I learned some new terms for concepts that were not necessarily new to me, namely “me too” drugs and iatrogenic loneliness. The most surprising set of facts from either text this week was Cruikshank’s (2013) descriptions of the normal bodily changes that occur with aging that can result in adverse drug reactions. This part of the text caused me to pause and assess my own medication.

It is common practice to think about how drugs affect children’s bodies, or even adults with smaller bodies, but I never knew about the bodily changes that can lead to adverse drug reactions for older adults. For example, decreased blood flow, higher percentage of body fat for older women, and decreased kidney and liver function. I appreciate the motto of some geriatricians “any new symptom in an older adult is a drug reaction until proven otherwise” (Cruikshank, 2013).

Throughout this course, my primary fear associated with aging that I’ve shared was to be poor, now I’m afraid that my Tums, ibuprofen, and allergy medicines are going to result in me having weak bones and depression when I’m older. I appreciate that Cruikshank (2013) frames this topic as a women’s issue. She makes an excellent argument considering hormonal changes, women’s exclusion in research, and women’s likelihood to live longer and in nursing homes.

Aronson (2019) recounts a story of Dmitri, a man with Parkinson’s disease who was nearly nonverbal and immobile, and how she tried to understand his condition and end-of-life wishes. When his daughter told Aronson that they had never explicitly discussed how he felt about end-of-life decisions, I was impressed with how Aronson pivoted to use of proxy questions to try and determine his preferences using implicit information and clues from similar situations among family and friends. I wonder if this is common training for doctors and other professionals working with people in what could be end-of-life stages. Legally speaking, can a family make decisions based on this kind of reasoning versus explicit directives regarding end-of-life care measures? It was fortunate in this case, that the information regarding Dmitri’s deteriorating condition and his prescription history revealed a “drug cascade.” Unfortunately, Aronson says this is common and all geriatricians have these kinds of stories. How do we avoid this as families, patients, and practitioners?

Later in this same chapter, Aronson discusses dementia and says, “the reality of living with it is complex, fraught, funny, infuriating, gratifying, tragic, and profound” (2019, p. 52). I think The Lost Tapes showed how varied people’s experiences can be, and I feel like that truly connects to what Aronson describes above. We saw in the documentary how people living in the early stages of dementia still had meaningful lives while they contemplated what it meant for the future of their family. The woman living with her mother who has later stage Alzheimer’s documented how her mother left small displays of artistic expression, which I think speaks to the profound experiences.

In reading about Aronson’s experience at the conference, I understand the course director’s worry of having overlapping information, but it is surprising to think that they did not consider that dementia is not multifaceted enough to be covered in different ways. Aronson offered a good solution to the issue to review the researcher’s slide and ensure there was no overlap. Assuming their audience consisted of physicians, her presentation seems more beneficial to patients; diagnostics for MCI, evaluation and management of driving risk, and quality of life and hospitalizations in patients with late-stage disease seems like information that will help practitioners, though the researcher’s information would probably help to understand the biology of dementia and drugs treatments. I’ve mentioned this before, but I cannot mention it enough. I was shocked to learn that many people upon diagnosis are given a prescription and told to get their life in order. No advice on how to live meaningfully. Aronson also mentioned that there are probably twice as many people living with dementia than diagnosed, this reminded me of an article that said doctors overestimate patients’ feelings of stigma regarding dementia (Lock et al., 2023)

Aronson shares an example of a physician named Gabow whose mother living with later stage dementia was recommended surgery by her doctors. What I think is important that Aronson pointed out about this anecdote is that Gabow had the “knowledge, authority, and money” to navigate systems on behalf of her mother and to seek alternative treatments (2019, p.57). Furthermore, Aronson demonstrates that standards of care are helpful but they don’t always consider the people with multiple diseases or conditions. In this case, the usual standard of care would have been intolerable for Gabow’s mother. I think Aronson’s expression was enlightening: our healthcare system often treats disease instead of illness—or how disease presents in an individual.

Aronson, L (2019). Elderhood: Redefining aging, transforming medicine, reimagining life (1st ed.). Bloomsbury US Trade.

Cruikshank, M. (2013). Learning to be old: Gender, culture, and aging (3rd ed.). Bloomsbury US Non-Trade.

Lock, S. L., Mehegan, L., & Rainville, C. (2023). Dementia stigma: Let’s stop it from stymieing solutions. Generations Journal, 47(1–9). https://www.proquest.com/docview/2821058259/54F665BF15C49DEPQ/4?accountid=11226&sourcetype=Scholarly%20Journals