Will GLP-1s Lead to Fewer Prescriptions for Older Adults?

As people age, they often develop chronic conditions, many of which need to be managed with multiple prescription medications. While medications are important for disease management, polypharmacy poses an increased risk for harmful side effects and contraindications.

In a new study published in the Journal of General Internal Medicine, Yale researchers sought to understand if polypharmacy—when patients take five or more drugs regularly—can be attributed to obesity in individuals aged 65 and older.

“Some in the medical community have theorized that if older adults are treated with GLPs, they can be on fewer medications because we're treating their obesity and thereby treating other obesity-related conditions,” says Alissa Chen, MD, MPH, instructor of medicine (general medicine) and first author on the study.

The researchers found that roughly 15% of polypharmacy cases were due to obesity, which equates to 3.3 million out of 22 million cases.

“While that is a lot of patients, there’s certainly a large majority of polypharmacy cases which are not attributable to obesity,” Chen adds.

The findings suggest that while obesity medications can improve obesity-related complications, they likely will not reduce the number of medications taken by individuals aged 65 and older.

The use of obesity medications in older adults is not well-studied.

“We’re at a crossroads for the use of obesity medications like GLPs in older adults. This study gives us a first glimpse into one way in which GLPs may change the face of health and healthcare for older adults,” says Alexandra M. Hajduk, PhD, MPH, research scientist (geriatrics) and senior author on the study.

Chen says that it’s important to consider that GLPs also have side effects, like nausea, acid reflux, or diarrhea, that may result in the addition of more over-the-counter or prescription medications.

Starting in July, obesity medications will be available at low cost for eligible Medicare patients under a federally funded program until December 2027. Under the temporary payment demonstration program, GLP medications will be broadly covered by Medicare for the first time.

During this time, a surge in GLP prescriptions for the treatment of obesity in this age group is expected. It is unknown how prices will change after the demonstration period ends; patients may be forced to discontinue their medications or pay out of pocket.

“Discontinuing can lead to worsened insulin resistance, and gaining more fat tissue than had been lost,” Chen says. “This may be dangerous, with some patients ending up in a worse situation after stopping than they were before starting.”

The study's findings highlight the importance of considering medication burden when treating older adults and call for further research to better understand how obesity medications affect health in older adults, the researchers say.

“The tried-and-true methods for polypharmacy are medical reconciliation and rational deprescribing,” says Chen. “Many of these approaches, developed by and publicized by the National Institutes of Health-funded U.S. Deprescribing Research Network, are effective tools for geriatricians and primary care doctors.”

Other authors include: Ashwin Chetty; John Batsis, MD; and Kasia Lipska, MD, MHS.