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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. / Thesis / Doctor of Philosophy (PhD)

Falls are a leading cause of injury and death in older adults. Numerous exercise interventions have been explored for fall prevention with their effectiveness being inconsistent. An alternative intervention based on motor learning concepts has potential to help prevent falls. Two separate studies are reported in this thesis. The purpose of the first study was to investigate if older adults exhibit short-term performance adaptation and long-term motor learning with repeated exposures to a simulated trip. While in a safety harness, participants stood on a treadmill that was quickly accelerated to simulate a trip. Improvements in trip recovery performance due to repeated exposures of a simulated trip included arresting the forward rotation of the trunk more quickly, reacting to the perturbation more quickly, and decreasing agonist/antagonist co-contraction. Overall, the results provide evidence for both short-term performance adaptation and motor learning. The purpose of the second study was to investigate if skills obtained from repeated exposure to a simulated trip transfer to recovery from an actual trip. Participants were randomly assigned to either an experimental or control group performing one trip before and after an intervention. The intervention for the experimental group consisted of trip recovery training on a treadmill while the intervention for the control group was walking on a treadmill. Overall, the results suggested beneficial effects of trip recovery training on actual trip recovery. These beneficial effects included decreasing maximum trunk angle, decreasing the time to reach maximum trunk angle, and raising minimum hip height during the initial recovery step. / Master of Science