Networks, Experts, and Paradoxes: Older Adults' Experiences of Polypharmacy and Perceptions of Deprescribing

Abstract

As medical researchers test the feasibility of deprescribing programs to reduce medication burden associated with polypharmacy, limited scholarly consideration has been given to the perspectives of the older adults largely targeted by these programs. This dissertation makes central the voices of older adults experiencing polypharmacy and/or deprescribing. Presented as a collection of three articles, this work explores the perspectives of older adults on their use of medication in the context of both polypharmacy and deprescribing. Data were collected using in-depth semi-structured qualitative interviews with older adults concurrently using 5+ prescription medications. The first article draws on Habermas’ writing on the contribution of communicative action in negotiating trust within complex social relationships. This analysis highlights the social nature of medication work and challenges to communicative action within personal and professional health systems. The second article applies embodiment theory to understand the way older adults’ construct unique forms of expertise regarding their health, resulting from a lifetime of experiences living as and in their bodies. The last article uses social constructionist theories on systems of classification to show the way dichotomies in medical classifications are often paradoxical. This article offers insight into the work older adults do to optimize their use of medicines in the context of these paradoxes. This study, in its entirety, indicates a need for collective efforts to identify and address the problems of polypharmacy while facilitating appropriate polypharmacy for older adults with complex multiple co-morbidities. Doing so encourages a reframing of polypharmacy as a complex phenomenon about which clinical judgments are made through an ongoing collaboration with the patient and family.