More Than a Diagnosis: Social Roles and the Medical Model of Aging
Stephanie Reyes
Blog Post 3 | Aging Practice, Policy & Research
When I think about older adults, I think about people who have lived entire lives, raised families, worked, experienced loss, and still have their own personalities and dreams. I do not automatically think about illness. However, these readings made me realize how often society reduces older adulthood to doctor visits, medications, and physical decline. Cruikshank and Aronson challenged me to think about what happens when being a patient becomes the main identity we allow someone to have.
What surprised me about overmedicalization
What surprised me most was the connection between the way we talk about aging and the way we treat older adults. Cruikshank (2013) explains that society places so much emphasis on bodily decline that illness begins to define older adulthood. Her description of the “roleless role” stood out to me because it suggests that people can reach this stage of life and find that society has little room for them beyond being recipients of care (Cruikshank, 2013, p. 42). That is a painful message to send someone who still wants connection, choice, and a meaningful place in the world.
The discussion of overmedication made that message even more troubling. I expected a discussion about too many prescriptions, but I had not thought as deeply about how our expectations of aging can make harmful treatment seem normal. If we already expect someone to become weak or less engaged because they are older, we might overlook the possibility that their treatment is contributing to those changes. To me, this connects Cruikshank’s discussion of social roles with her criticism of medicalization: once we see someone mainly as sick, we may stop asking what else is happening in their life (Cruikshank, 2013).
I also appreciated her push toward a broader vision of care. Her discussion of alternatives encouraged me to think about social connection, movement, emotional support, and the environment someone lives in, alongside medical treatment (Cruikshank, 2013). I would still want any treatment to be evaluated for safety and benefit. What matters to me is making room for approaches that support the whole person rather than assuming that every difficulty needs another prescription.
Dimitri’s daughter and the power of being heard
Dimitri’s story was the part that stayed with me most. A medication caused a problem, another medication was added to treat that problem, and the cycle continued until he went from healthy to bedbound. After Aronson reviewed and changed his medications, he began sitting up, talking, eating more, and moving better (Aronson, 2019). It was upsetting to think about how easily those changes could have been accepted as an unavoidable part of getting older.
What matters most to me about Aronson’s interaction with Dimitri’s daughter is the importance of taking a family member’s account seriously. The excerpt shows that the pharmacy records supported the daughter’s description of his decline (Aronson, 2019). Her knowledge of her father’s life helped make sense of what was happening. Medical expertise matters, but so does knowing how someone functioned before a treatment began.
As a mother and someone who has dealt with health challenges, I understand how much it matters to feel heard. I can imagine how intimidating it would be to question a treatment plan when the person making the decisions has authority and specialized knowledge. This example made me think about the responsibility that comes with that power. Families should be able to ask questions without feeling that they are being difficult.
I also noticed that Aronson monitored Dimitri closely after changing his medications and adjusted his blood pressure treatment when needed (Aronson, 2019). That mattered because she remained responsible for his comfort and care. For me, the lesson is that a physician’s willingness to reconsider a treatment plan can be just as important as the willingness to start one.
When dementia becomes the image of aging
I understood Cruikshank’s statement that Alzheimer’s disease stands for aging in America to mean that one condition has become a symbol for an entire stage of life. Instead of seeing the variety of older adults’ experiences, we focus on a frightening image of losing memory, independence, and identity (Cruikshank, 2013). That can make younger people fear aging before they have even considered its possibilities.
This also raises a concern for me about how we view people who actually live with dementia. Challenging stereotypes about aging should include protecting their dignity, too. A person’s need for assistance does not make their life less valuable. They still have feelings, relationships, preferences, and a need to belong.
I understand Aronson’s approach as asking what care makes sense for the individual rather than allowing a diagnosis or a standard medical response to decide everything (Aronson, 2019). In thinking about the “Confusion” section, the question I keep coming back to is whether treatment helps the person in their actual daily life. Their comfort, remaining abilities, and relationships should matter alongside their symptoms.
I see the shift toward this approach as unfinished. The idea of care centered on the person gives me hope, but I do not think we have fully separated aging from the fear of dementia. Even comments about someone having a “senior moment” show how easily we connect getting older with cognitive decline. As a future social worker, I want to challenge those assumptions while supporting people who need care, rather than making independence a requirement for respect.
What the current research added
I chose a 2024 peer-reviewed review by Robinson and colleagues about deprescribing in older adults experiencing polypharmacy. Its focus is medication use rather than dementia. The authors explain that several medications can be appropriate; the concern is whether their harms outweigh their benefits. They identify barriers to deprescribing, including limited time, fragmented communication, fear of negative outcomes, and the perception that stopping medication means abandoning care (Robinson et al., 2024).
That last point helped me understand why changing treatment can be emotionally difficult. The review supports regular medication reviews, collaboration, and shared decisions (Robinson et al., 2024). Compared with Cruikshank’s cultural critique and Aronson’s individual example, it adds practical ways to respond within health care.
I still wonder who takes responsibility when several specialists prescribe for one person. How can families raise concerns safely, and how can people with limited resources access a thorough review?
These readings left me thinking about the kind of social worker I want to become. I want to help older adults express what matters to them, stay involved in decisions, and maintain meaningful relationships and roles. Their worth should never depend on how healthy, independent, or productive they are. Getting older should not mean disappearing behind a diagnosis.
References
Aronson, L. (2019). Elderhood: Redefining aging, transforming medicine, reimagining life. Bloomsbury Publishing.
Cruikshank, M. (2013). Learning to be old: Gender, culture, and aging (3rd ed.). Rowman & Littlefield.
Robinson, M., Mokrzecki, S., & Mallett, A. J. (2024). Attitudes and barriers towards deprescribing in older patients experiencing polypharmacy: A narrative review. npj Aging, 10, Article 6. https://doi.org/10.1038/s41514-023-00132-2
Stephanie,
This was an excellent post and very well done. You have hit all of the major points discussed in these readings and then some. You heard Cruikshank talk about how wew have equated both medication and growing older, as well as growing older and dementia. These are really good connections from what we read.
It’s also true that Dimitri’s case helped us see the importance of asking the right questions until we get the right answers. That’s a lesson for us as social workers as well.
Your article selection was really good. I will be saving that one and reviewing it more carefully. They lay out a plan for deprescribing, including the barriers and the important reasons to go forward. All of us tend to hang on to our treatment plans, no matter what we may be facing medically. An interesting perspective.
Really, really good job. I am glad your eyes are getting better.
Dr P