GLP-1 Medications After 65: What Older Adults Should Know

Keeping a healthy weight and preventing or managing diabetes matter at every age, but those goals become even more important as people get older.

With advancing age, obesity and diabetes raise the chances of heart disease, stroke, kidney disease, dementia and cancer.

To help lower those risks, many people are turning to GLP-1 drugs such as semaglutide, sold as Ozempic and Wegovy, and tirzepatide, sold as Mounjaro and Zepbound.

For adults 65 and older who are thinking about a GLP-1, there are special issues to consider, according to UNC Health geriatrician John Batsis.

“The promise of these medications is great, but when it comes to older adults, we still need more data and research for this specific population,” Batsis says.

Here is his advice for older adults who are starting a GLP-1.

Potential benefits and risks for people over 65

When GLP-1 medications were being developed, they were tested largely in adults under 65, Batsis says.

“It’s important to note that we do not have any guidelines specific to older adults and how we should approach using these medications with them,” he says. “Ask different experts, you might get different opinions.”

The possible benefits, including weight loss and better blood sugar control, do not change with age, but the risks can differ.

These medications are known to cause gastrointestinal side effects such as nausea, constipation and reduced appetite, which can be especially troublesome for older adults.

“You’re already more susceptible to dehydration and constipation as you age, and then if those are increasing on these medications, you really need to push fluid intake and monitor bowel movements,” Batsis says.

Weight loss can also lead to loss of muscle and bone mass, something that already tends to happen with aging, especially for people who are not active. That added loss can raise the risk of osteoporosis, frailty, falls and lasting disability, and the danger is greater if the weight comes off quickly because of medication.

“It’s really important to focus on building muscle strength and muscle quality, especially when you’re losing weight,” Batsis says.

Advice for older adults beginning a GLP-1

If you are 65 or older, Batsis offers several recommendations for starting a GLP-1:

Prioritize a balanced diet, regular exercise and hydration

Anyone beginning a GLP-1 should be working on healthy habits, including more protein and fiber, a balanced diet, plenty of water and regular physical activity, including strength training. That is especially important for people over 65.

“Ideally, starting on a GLP-1 is a team-based effort, and you’re working with your doctor, a dietitian and an exercise specialist, whether that’s a personal trainer or a physical therapist,” Batsis says. “When someone has been engaging in all of those lifestyle interventions and still can’t lose weight, then they might be a good candidate for a GLP-1.”

If you are not yet meeting the recommended 150 minutes of moderate cardio exercise plus 60 minutes of strength training each week, begin with what you can do.

“Something is always better than nothing,” Batsis says. “It’s OK to start with 10 minutes of movement a day.”

These habits can help the medication work more effectively while also limiting side effects.

Think in terms of function, not just weight

Many people focus on dramatic weight loss stories, but Batsis says he prefers to ask what a person wants to be able to do that they cannot do now, rather than centering on a number on the scale.

“For many people, that might be getting down on the floor with grandkids or being able to enjoy walking around their block,” he says.

Losing about 10% to 15% of body weight over time has been shown to lower high blood pressure and high blood sugar while helping limit muscle loss, Batsis says. For older adults in particular, the focus should be on what matters most, which is often quality of life and physical function.

Start with a low dose and increase slowly

These medications usually have five or six dose levels. People begin with a low dose so the body can adjust, then gradually increase it. Reaching the full dose can take months.

People over 65 may need to go even more slowly, and some may never need the highest dose to reach their goals.

“I like to start low and go slow,” Batsis says. “Rapid weight loss is not good for anyone because of the risk of muscle loss.”

Starting low gives the body more time to adapt to side effects and allows patients to keep working with their care team on nutrition and exercise.

Going slowly also gives doctors time to see how the body is responding so they can make changes if needed. That is one reason Batsis says patients should see a doctor instead of relying on the internet.

“I strongly advise against the compounded medications available online,” Batsis says. “For safety, you should be under clinical supervision.”

Pay close attention to how you feel

Batsis says he is seeing older patients who lost significant weight on medication but experienced functional decline because of muscle loss. One example, he says, is a patient in his 80s who lost 50 pounds in six months, improved his diabetes, but had worsening mobility.

“In six months, he’d barely been able to play golf and had to start using a walker,” Batsis says. “If function is declining like that, we need to adjust the dosing or you may need a different medication. Once we decreased his dosing, his function improved.”

As people age, what they can do and how they do it naturally changes. It can be difficult to tell whether a change is simply part of aging or a medication side effect, which is why staying in close touch with a care team is so important.

“Communication is so important,” Batsis says. “One-size-fits-all is not how we should approach these medications. It really needs to be individualized so that it’s right for you.”