GLP-1 receptor agonists and dual GLP-1/GIP agonists are increasingly prescribed to older adults. This JAGS framework paper sets out how to prescribe them within the Geriatrics 5Ms — Mind, Mobility, Medications, Multicomplexity and Matters Most.
The authors highlight risks that weigh more heavily in later life: a substantial share of drug-induced weight loss may be lean mass, along with dehydration, malnutrition, aspiration around anaesthesia, and fat-predominant regain after stopping. They work through scenarios including frailty, cognitive impairment, glucocorticoid use and surgical planning.
Their central recommendation is that these drugs should come with resistance training, adequate protein and ongoing monitoring of function, not weight alone. This is expert guidance rather than trial evidence; age-stratified trials with body composition and function outcomes are still lacking.
For clinicians prescribing these drugs to older adults, it shifts the goal from weight lost to function kept.
- Measure function — grip strength, gait speed or chair stands — before starting and during treatment.
- Prescribe resistance training and adequate protein alongside the drug.
- Watch for poor intake, dehydration and unintended loss of muscle.
- Plan for the anaesthetic aspiration risk before elective surgery.
- Discuss what matters most to the patient before choosing weight loss as a goal.
Why it matters
In an older adult, weight lost as muscle can turn a metabolic gain into a mobility loss.
Don't overread it
This is an expert framework, not trial evidence of benefit or harm in older adults.
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