Joshua Gaston

Aging Practice
September 26, 2026

Blog Post 3 Social Roles and the Medical Model of Aging

The readings challenged me to separate aging itself from the illnesses, medications, and social assumptions that often surround it. My main takeaway is that medicine can extend and improve life, but it can also narrow how professionals and families see an older person. Good care therefore requires more than treating diagnoses. It requires listening to the person, examining the full medication picture, and protecting the older adult’s dignity and role in decisions.

1 What Surprised Me About Overmedicalization

What surprised me most was not simply that older adults may receive too many medications, but how easily the entire aging process can become interpreted as a medical problem. Cruikshank explains that American society emphasizes bodily decline and assigns older adults a sick role or even a roleless role, as though illness and dependence erase their social value (Cruikshank, 2013). Once that viewpoint becomes normal, every change may appear to require a diagnosis, prescription, procedure, or professional intervention. The older adult’s relationships, purpose, spirituality, culture, and daily environment can become secondary. I was especially struck by the number of participants involved in maintaining this system, including clinicians, health care institutions, businesses, families, and patients who have learned to expect a medical response.

This reading also made me think about my father’s battle with cancer. Medical treatment was necessary, and I would never dismiss the value of skilled physicians or medication. At the same time, serious illness taught me that a person can quickly become known mainly by a disease, test result, or treatment plan. Cruikshank helped me see that the problem is not medicine itself; the problem is allowing the medical model to define the whole person. Her discussion challenged me to ask whether a treatment supports an older adult’s functioning and goals or merely adds another layer of control to a life already being defined by others.

2 The Conversation With Irina

Aronson’s conversation with Irina, Dimitri’s daughter, was powerful because Irina knew who her father had been before his rapid decline. Her account gave Aronson the timeline needed to look beyond the assumption that Dimitri had simply reached the final stage of Parkinson’s disease or dementia. Aronson recognized a prescribing cascade: a blood-pressure medication contributed to gout, the gout was treated with a strong anti-inflammatory medication that caused another problem, and additional prescriptions followed instead of the original medication plan being reconsidered. By the time Dimitri entered the nursing home, the effects of treatment had been mistaken for irreversible decline. When the medication burden was reduced, he improved enough to leave the dementia unit, move to assisted living, and return to painting (Aronson, 2019).

My reaction to the conversation was that family members must be treated as important sources of knowledge, especially when a patient cannot fully speak for himself. A medical chart may list symptoms and prescriptions, but Irina could describe changes in her father’s personality, abilities, and functioning over time. The exchange also exposed the unequal power between physicians and families. People are often taught not to question a doctor’s authority, even when they sense that something is wrong. Aronson did not dismiss Irina’s concerns; she listened and investigated. As a father and future social worker, that stood out to me because respectful care should combine professional expertise with the lived knowledge of patients and caregivers.

3 Dementia as a Symbol of Aging

When Cruikshank argues that Alzheimer’s disease stands for aging in America, I believe she means that dementia has become a cultural symbol for everything people fear about growing old: losing memory, independence, identity, control, and social worth. This image is so powerful that people may treat any forgetfulness or confusion as proof of inevitable decline. That is inaccurate and harmful because dementia is a disease, not a normal or universal result of aging. It also reduces the wide range of later-life experiences to one frightening picture and makes younger people fear older adulthood before they have experienced it (Cruikshank, 2013).

Aronson’s approach is more careful and person-centered. She does not treat confusion as a complete explanation or accept age as the cause without further investigation. Instead, she asks what changed, what medications are involved, what the person’s baseline functioning was, what other conditions might be contributing, and what outcome matters to the patient and family (Aronson, 2019). Her approach preserves the personhood of someone living with cognitive impairment and recognizes that dementia can coexist with emotion, relationships, preferences, and meaningful activity. This is personal for me because my grandfather lives in assisted living due to dementia. His diagnosis affects his life, but it is not the totality of who he is or what he has meant to our family.

I believe health care has moved somewhat toward Aronson’s approach through geriatrics, person-centered memory care, caregiver involvement, and greater awareness of delirium and medication effects. However, the larger culture still often treats dementia as the face of aging. Fear-based language, jokes about memory, and the tendency to speak around older adults instead of to them show that Cruikshank’s critique remains relevant. Progress will require both better clinical practice and a social change in how we understand dependence, memory loss, and human value.

4 What I Learned From Current Research

For my current peer-reviewed source, I selected Ouellet et al. (2022), a qualitative study of prescribing and deprescribing among adults age 80 and older. The researchers interviewed 10 very old adults and six caregivers and conducted group interviews with 11 health professionals. The most important finding was a gap in perception. Older adults and caregivers generally viewed multiple medications as a normal and necessary part of advanced age and trusted the physician to decide what should continue. Health professionals were more likely to recognize inappropriate medication use, yet they described barriers to deprescribing such as limited time, inadequate training, fragmented communication, fear of harming the therapeutic relationship, and the authority built into medical hierarchy.

The article strengthens both course readings. Like Cruikshank, it shows that overmedicalization is socially constructed and normalized; medication use becomes part of what people believe old age is supposed to look like. Like Aronson, it demonstrates how physician authority can discourage patients and caregivers from questioning a treatment plan. Dimitri’s case shows the potential harm at the individual level, while Ouellet et al. (2022) show the broader culture that allows medication burden to appear ordinary. The study also helped me understand that deprescribing is not simply taking medicine away. It should be a careful, shared review of whether each medication still serves the person’s goals and whether its benefits outweigh its risks.

I still wonder how race, culture, income, health literacy, and access to geriatric specialists affect a person’s willingness and ability to question prescriptions. I would also like to know whether routine medication reviews led by physicians, pharmacists, nurses, and social workers reduce preventable harm without causing needed treatment to be withheld. That balance matters because avoiding overmedicalization must never become another form of ageism in which pain or illness is ignored merely because a person is old. The goal should be individualized care that neither treats aging as a disease nor dismisses real medical needs.

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.

Ouellet, N., Bergeron, A.-S., Gagnon, E., Cossette, B., Labrecque, C. A., & Sirois, C. (2022). Prescribing and deprescribing in very old age: Perceptions of very old adults, caregivers and health professionals. Age and Ageing, 51(11), afac244. https://doi.org/10.1093/ageing/afac244