Medication Burden Increased Across Frailty Levels Among Older U.S. Adults

An observational study in the Journal of the American Geriatrics Society examined prescription medication use across frailty levels using nationally representative NHANES data from 1999 through March 2020. Of 14,962 community-dwelling adults aged 65 years or older, 12,766 had sufficient data to construct a frailty index. Researchers classified participants as robust, mildly frail, or moderately to severely frail and assessed medication counts and therapeutic classes, accounting for the complex survey design.

Between 1999–2000 and 2017–2020, mean prescription medication counts rose from 2.0 to 2.9 among robust adults, 3.9 to 5.5 among mildly frail adults, and 6.0 to 7.8 among those with moderate to severe frailty. Trends were statistically significant in all groups. Cardiovascular agents consistently represented the largest share of polypharmacy, but their use remained stable. Metabolic agents increased across all frailty groups, while CNS/psychotherapeutic agents increased primarily among those with moderate to severe frailty.

Among adults taking at least 10 medications in 2017–2020, therapeutic composition also differed by frailty status: CNS/psychotherapeutic and topical agents predominated among robust adults, versus cardiovascular and metabolic agents among frail adults. These findings provide context for medication review across the frailty spectrum, but do not establish prescribing appropriateness or benefits from deprescribing. The observational analysis does not establish causality, and only the abstract was available for this assessment.