I found the fact that Americans prefer quick fixes and expect their doctors to prescribe medication rather than changing their lifestyle habits surprising, but it does make sense. Our culture promotes efficiency, and you see it all over, whether it be fast food drive-throughs or delivery services; we value our time and want immediate relief. I think this issue comes from the hustle culture, and because we are so overworked, changing our diet and exercising takes longer to see results. After finishing the reading, it made more sense why elderly people assume and expect to be medicated and how providers and the drug market push it onto them. “This cultural preference for a fast solution may predispose elderly people to expect doctors to prescribe drugs for them and to feel disregarded if they are given none.” (Cruikshank, 2013) I enjoyed reading about alternatives to medication like herbalists and homeopathic doctors, and how other countries integrate this form of healthcare.
I thought her conversation with Svetlana was jarring, as Dimitri had been a victim of a “prescribing cascade,” and the side effects of his medication resulted in another medication, which worsened his condition. I appreciated how the author said that any doctor or pharmacist who looked thoughtfully at Dimitri’s medications and didn’t use his old age and apparent advanced illness as an excuse to forgo obtaining a detailed medical history would have come to the same conclusion I did (Arson, 2019). The conversation with his daughter was needed to gain more information on Dimitri, and ultimately saved his life.
In Aronson’s approach to dementia, she viewed dementia from a different scope, including quality of life, relationships, environment, and caregiver needs, rather than dementia being a neurological disease that needs to be diagnosed and medicated. She argues that doctors and other professionals should focus on other skills to help their patients, not just a scientific standpoint. “The needed expertise includes helping patients manage the practical challenges and existential distress of a dementia diagnosis; techniques for communicating with people with different types and stages of cognitive impairment; the ability to recognize and manage caregiver distress; mastery of not just drugs but also less toxic and more effective social, behavioral, and environmental approaches to symptoms; and prowess in navigating the difficult terrain of life planning, family grief, conflict, and tough decision-making as the disease progresses. (Aronson, 2019).
I hope that our healthcare system has moved towards Aronson’s approach, but there still needs to be work, as gerontology is the last pick for most students. I think dementia care involves more than medication and recognizing how caregivers and social environments can be affected. Aging in America is not seen as dementia, but it can be related through decline, dependence, and loss of identity.
What did you learn from the article you chose? How does it compare with what you learned in Cruikshank and Aronson? Are there things you still wonder about, and what do you still like to know regarding this issue?
I chose the article Influence of Social Determinants of Health on Quality of Life in Patients with Multimorbidity and Polypharmacy because it argues for a biopsychosocial approach to caring for older adults, and I learned about this approach in another class. I learned that an older adult’s quality of life is influenced by income, education, social support, and environment much more than their physical health. I learned about care that prioritizes individual circumstances rather than focusing only on their medical issues. “Polypharmacy should consider medical constraints, pathological needs and patients’ feelings and fears, implying future studies on the accurateness of prescription and the need of deprescription.” (Simoes et al, 2020)
This connects with what I learned from Cruikshank and Aronson because they both emphasized that aging should be viewed as a complex experience rather than a downward spiral of decline. Especially because Aronson discusses looking at the patient as a whole person and considering their quality of life, environment, and relationships, and supports the article I chose. I would like to know more about the role a social worker may take in helping older adults access resources and manage healthcare needs to improve their quality of life.
References
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.
Simões, P. A., Santiago, L. M., & Simões, J. A. (2020). Prevalence of polypharmacy in the older adult population within primary care in Portugal: a nationwide cross-sectional study. Archives of medical science : AMS, 20(4), 1118–1127. https://doi.org/10.5114/aoms.2020.93537
I liked your connection between quick fixes and hustle culture. When people have limited time and energy, taking medication may feel more manageable than making changes to diet, exercise, or daily routines. Your point also made me think about whether providers have enough time to discuss those options with patients before writing a prescription.
Dimitri’s story stood out to me, too. The prescribing cascade shows why it matters to review a person’s full medication history and listen to family members who have noticed changes. I also appreciated your focus on quality of life in dementia care. A diagnosis does not tell a provider everything about someone’s relationships, surroundings, or needs.
Your question about social work is one I would like to explore further. I think a social worker could help an older adult explain their goals to the care team, connect with community resources, and make sure their own preferences remain part of treatment decisions. What do you think would help social workers have a stronger voice in those conversations?
I agree with your point about how important it is to look at the whole person instead of just their medical conditions. I also thought the example of Dimitri was a good example of how medications can sometimes create more problems when the side effects are not recognized. I liked that you mentioned the role of social workers because I think they can really help with the social and environmental factors that affect older adults. What do you think is the biggest way social workers can help reduce unnecessary medications?
Hi Emilie, I too thought the conversation was jarring in the fact that in the daughter’s mind, she’s answering basic medical questions on behalf of her father, not realizing she gave all the information to help Aronson solve the sudden decline of her client. Another thing my brain made note of in this interaction was the cultural aspect that Svetlana was uncomfortable talking about in the event of care for her father.
Hi, Emilie, I like how you mention the focus on efficiency in our culture. This, along with our hyperindividualism, negatively impacts people who cannot keep up with this standard. This is often older people or those with disabilities. I think the overmedicalization of this group results from overworked, quick-solution-focused staff at hospitals and doctors’ offices who have little choice but to follow the plans insurance companies already have in place. However, I think this method of treating people often puts people into a “sick” position that is hard to identify with. What do you think about the cause of this?
Emilie,
This is a really well-done post. You bring a perspective to the issue of over-medication that Cruikshank mentions, but you take it further. I have had this argument with people about antibiotics and kids, but this is yet another extension of this process. Your distinctions between Cruikshank’s comment on dementia and Aronson’s are spot on. The real issue is seeing more than the disease. And I agree with you that we aren’t there yet.
You article was fine based on the requirements I stipulated. I think AI is typically offering all of you international articles – not quite sure why – but since I made no requirement for a US based research article, it is fine. You might have learned a bit more about the problem over over-medication in the US with an alternative selection. And remember, if you use a direct quote – you need to include a page number in your parenthetical reference.
Good discussion.
Dr P