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      “At 80 I Know Myself”: Embodied Learning and Older Adults’ Experiences of Polypharmacy and Perceptions of Deprescribing

      research-article
      , PhD 1 , , PhD 1
      Gerontology and Geriatric Medicine
      SAGE Publications
      polypharmacy, deprescribing, older adults, embodied learning, embodied knowledge

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          Abstract

          In response to the risks of polypharmacy for older adults, there are increasing calls for the development and implementation of deprescribing programs. This article examines the forms of expertise that inform older adults’ decisions about how to use medications given concerns over polypharmacy and a clinical focus on deprescribing. In-depth interviews with older adults found that diverse knowledge sources underpin decisions regarding polypharmacy and deprescribing. Findings indicate that this knowledge is formed through a lifetime of embodied learning—the production of relevant knowledge through lived experiences of the body. By way of this embodied learning, older adults possess individualized knowledge bases that inform health and health care decisions, especially regarding the use of medications. If deprescribing programs are to be embedded into standard preventive medical care of older adults, then it is valuable for health care providers to be aware of and take seriously the contribution of embodied knowledge.

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          Most cited references27

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          Systematic methodological review: developing a framework for a qualitative semi-structured interview guide.

          To produce a framework for the development of a qualitative semi-structured interview guide.
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            Polypharmacy in elderly patients.

            Polypharmacy (ie, the use of multiple medications and/or the administration of more medications than are clinically indicated, representing unnecessary drug use) is common among the elderly. The goal of this research was to provide a description of observational studies examining the epidemiology of polypharmacy and to review randomized controlled studies that have been published in the past 2 decades designed to reduce polypharmacy in older adults. Materials for this review were gathered from a search of the MEDLINE database (1986-June 2007) and International Pharmaceutical Abstracts (1986-June 2007) to identify articles in people aged >65 years. We used a combination of the following search terms: polypharmacy, multiple medications, polymedicine, elderly, geriatric, and aged. A manual search of the reference lists from identified articles and the authors' article files, book chapters, and recent reviews was conducted to identify additional articles. From these, the authors identified those studies that measured polypharmacy. The literature review found that polypharmacy continues to increase and is a known risk factor for important morbidity and mortality. There are few rigorously designed intervention studies that have been shown to reduce unnecessary polypharmacy in older adults. The literature review identified 5 articles, which are included here. All studies showed an improvement in polypharmacy. Many studies have found that various numbers of medications are associated with negative health outcomes, but more research is needed to further delineate the consequences associated with unnecessary drug use in elderly patients. Health care professionals should be aware of the risks and fully evaluate all medications at each patient visit to prevent polypharmacy from occurring.
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              The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis.

              Deprescribing is a suggested intervention to reverse the potential iatrogenic harms of inappropriate polypharmacy. The review aimed to determine whether or not deprescribing is a safe, effective and feasible intervention to modify mortality and health outcomes in older adults.
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                Author and article information

                Journal
                Gerontol Geriatr Med
                Gerontol Geriatr Med
                GGM
                spggm
                Gerontology and Geriatric Medicine
                SAGE Publications (Sage CA: Los Angeles, CA )
                2333-7214
                20 December 2019
                Jan-Dec 2019
                : 5
                : 2333721419895617
                Affiliations
                [1 ]McMaster University, Hamilton, Ontario, Canada
                Author notes
                [*]Alison Ross, McMaster University, Kenneth Taylor Hall, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4L8. Email: rossas@ 123456mcmaster.ca
                Author information
                https://orcid.org/0000-0002-6387-638X
                Article
                10.1177_2333721419895617
                10.1177/2333721419895617
                6926975
                ff0b813b-e734-4131-9708-0c109758dbc5
                © The Author(s) 2019

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 10 October 2019
                : 25 November 2019
                : 26 November 2019
                Funding
                Funded by: Labarge Optimal Aging Initiative, ;
                Award ID: 2016-04
                Categories
                Article
                Custom metadata
                January-December 2019
                ts1

                polypharmacy,deprescribing,older adults,embodied learning,embodied knowledge

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