The edition · Geriatrics
Frail older US adults now take nearly eight prescription drugs on average, and the rise is in metabolic and CNS agents
Two decades of US survey data show medication counts climbing at every level of frailty. Also: motivational interviewing for older people at risk of abuse, a light-touch social care service for dementia caregivers, and possible osteosarcopenia linked to early cognitive decline.
The edition in brief
Nationally representative NHANES data on 12,766 adults aged 65 or over, from 1999 to 2020, show the mean number of prescription medicines rose from 2.0 to 2.9 in robust people, 3.9 to 5.5 in the mildly frail and 6.0 to 7.8 in those with moderate to severe frailty. Cardiovascular drugs were the largest share but stable; the growth came from metabolic agents across all groups and from CNS and psychotropic drugs in the most frail. This points structured medication review at the frailest patients and at sedatives, antidepressants and glucose-lowering drugs. In Hong Kong, four motivational interviewing sessions for 198 older adults at risk of abuse reduced minor psychological aggression and caregiver neglect and improved self-efficacy compared with wait-list control. A low-intensity resource referral and navigation service for dementia caregivers did not improve self-efficacy at 12 months but was associated with fewer emergency visits among those with social needs. In 2,291 Singaporean older adults, half had possible osteosarcopenia, which was linked to lower intrinsic capacity and poorer cognition six months later. The pearl covers anticholinergic burden.
Motivational interviewing reduced some forms of abuse in at-risk older adults
Consider motivational, goal-focused support for older adults at risk of abuse, alongside safeguarding, rather than advice alone.
A light-touch resource service for dementia caregivers: fewer emergency visits, same confidence
Screen dementia caregivers for practical social needs and link them to local help; it may reduce emergency use.
Possible osteosarcopenia linked to lower intrinsic capacity and early cognitive change
Check bone and muscle together in older adults, and consider screening cognition when both are low.
Add up the anticholinergic burden
Total the anticholinergic load of an older patient's medicines and reduce it wherever possible.
Medication counts have risen most in the frailest, led by metabolic and CNS drugs
Treat frailty as a trigger for medication review, starting with CNS drugs and glucose-lowering treatment.
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