Tag: Older Adults

The Hidden Health Risk After 65 May Be Inside the Medicine Cabinet

A new 2026 JAMA study finds that more than one in five older Americans used medication combinations with potentially major drug interactions. Here is what the findings mean, what they do not prove, and why people over 60 should periodically review prescriptions, OTC medicines and supplements together.

I recently looked at the medicines an older person can accumulate without doing anything obviously reckless. There may be tablets for blood pressure in one place, diabetes medicines nearby, perhaps aspirin or another heart medicine. Then come the things we hardly think of as medicines: a painkiller bought without prescription, a vitamin, an herbal preparation.

Each may have a perfectly sensible reason for being there.

The trouble can begin with the combination.

A new study published in JAMA on September 24, 2026 provides an uncomfortable reminder of this problem. Researchers found that more than one in five older Americans in their latest survey period were using a medication regimen containing at least one potentially major drug-drug interaction.

That does not mean one in five suffered serious harm. The distinction matters.

It does mean that medicine cabinets deserve more attention as we grow older.

More medicines, but not necessarily more safety

Researchers led by Dima Mazen Qato of the University of Southern California examined nationally representative data from community-dwelling Americans aged 62 to 85. They compared 2,754 people surveyed in 2015–2016 with 2,186 surveyed in 2021–2023.

The results contain an interesting contradiction.

Prescription polypharmacy, defined in this study as taking five or more prescription medicines concurrently, increased from 31.0 percent to 35.7 percent.

Supplement polypharmacy also increased, from 12.6 percent to 16.7 percent.

Yet exposure to regimens containing potentially major drug interactions actually declined, from 25.7 percent to 22.3 percent.

So the story is not simply that older people are swallowing more tablets and medicine has become less safe. Prescribing appears to have improved in some areas. Even so, 22.3 percent remains a striking figure.

Roughly one in five people in this American sample was still exposed to a combination that researchers classified as potentially capable of causing a major interaction.

The word potentially needs to stay in that sentence.

The study identified interacting medication regimens. It did not establish that every person taking them experienced an adverse event. The researchers themselves list the absence of data on actual adverse drug events as an important limitation.

That restraint makes the findings more useful, not less.

The 63,000 reports that caught my attention

Another number in the JAMA paper deserves careful reading.

The researchers report that between 2015 and 2025, approximately 63,000 serious adverse events attributed to drug-drug interactions were reported to the US Food and Drug Administration among adults aged 65 and older. About 10 percent of those reports involved a fatal outcome.

It would be tempting to turn that into a frightening headline. I will not.

Spontaneous adverse-event reports are valuable for detecting safety signals, but a report does not by itself prove that a particular interaction caused the patient’s injury or death. Reporting systems can also contain incomplete information and are not designed to calculate the incidence of an event in the whole population.

Still, 63,000 serious reports tell us something important.

Medication interaction is not an obscure theoretical problem.

Which medicines appeared most often?

The JAMA researchers also examined the therapeutic classes appearing in potentially major interacting regimens.

In 2021–2023, antidepressants were the most common, appearing in such regimens among an estimated 7.21 percent of older adults. Statins followed at 5.23 percent, while antiplatelet therapies appeared at 4.47 percent.

Those figures should not be read as warnings to abandon antidepressants, statins or antiplatelet medicines.

Quite the opposite.

These drugs can provide substantial benefits when properly prescribed. A person at cardiovascular risk may have a strong clinical reason for taking a statin or antiplatelet drug. Someone with depression may genuinely need an antidepressant.

The problem is the combination, dose, patient’s condition and other medicines being taken.

One change in the study particularly caught my eye. Potentially interacting regimens involving opioid analgesics declined from 5.56 percent to 4.04 percent. Those involving benzodiazepines fell from 2.05 percent to 0.87 percent.

But interacting regimens involving muscle relaxants increased from 1.35 percent to 2.49 percent.

The authors argue that greater attention should now be paid to those combinations.

Medicine safety, in other words, is a moving target.

Age changes what a medicine does to us

There is another reason this becomes important after 60.

Our bodies do not process medicines exactly as they did when we were 30.

The US Food and Drug Administration points out that ageing can change how medicines work in the body. Kidney and liver function may decline, affecting how drugs are broken down or eliminated.

A dose tolerated for years may therefore deserve review later.

Some medication effects can also look like new diseases. The FDA specifically mentions symptoms such as dizziness, sleepiness and memory difficulties.

Imagine what can happen.

An older person becomes dizzy. Everyone assumes it is simply age. He becomes unusually sleepy, so the family worries about weakness. Memory seems poorer and dementia enters the conversation.

Sometimes the explanation may indeed be disease.

But sometimes the medication list deserves inspection.

The tablet bought without a prescription still counts

Here in Karachi, I think this is where the issue becomes especially practical.

People often distinguish between a doctor’s medicine and something they bought themselves. The body makes no such distinction.

A painkiller from the pharmacy remains pharmacologically active. So does an antihistamine. So does an herbal preparation.

Supplements deserve the same attention.

The FDA warns that dietary supplements can alter the absorption, metabolism or excretion of medicines. That can increase or reduce the amount of a drug effectively reaching the body.

Some combinations can increase bleeding risk.

Others can change how well a medicine works.

“Natural” tells us something about marketing or origin. It does not establish that a product cannot interact with prescription medicine.

That small distinction belongs on every older person’s medication list.

Polypharmacy is not automatically bad medicine

There is another trap here.

After reading about polypharmacy, someone may conclude that taking five medicines is inherently dangerous and decide to eliminate a few.

Please don’t.

For someone living with several chronic illnesses, multiple medicines may represent entirely appropriate treatment.

The question is not simply: How many tablets am I taking?

A better question is: Do I still need each one, at this dose, in this combination?

The World Health Organization’s work on medication safety and polypharmacy takes this person-centred approach. WHO stresses the importance of medication review while recognising that people with several long-term illnesses may legitimately need multiple treatments.

Britain’s National Institute for Health and Care Excellence makes a similar point. It recommends considering structured medication reviews for older people, those with chronic conditions and people taking multiple medicines.

The purpose is not a tablet-counting exercise.

It is to determine whether treatment still makes sense for that particular person.

Bring the whole medicine cabinet to the conversation

A useful medication review should include more than prescriptions.

Write down every regular medicine. Add medicines taken only occasionally.

Then include vitamins, herbal preparations and dietary supplements.

For each item, record the dose and why you take it.

The FDA recommends keeping an up-to-date medication list and sharing it with healthcare professionals. Keeping one pharmacy involved where practical can also help because a pharmacist may see combinations prescribed by different doctors.

There are several questions worth asking during a review.

  • Why am I still taking this medicine?
  • Is the dose still appropriate for my age and kidney or liver function?
  • Could any of these medicines interact?
  • Could one of them explain dizziness, sleepiness, stomach trouble or another new symptom?
  • Does an over-the-counter medicine or supplement change the picture?

One question may lead to another. That is fine. Medication review is supposed to be a clinical conversation, not an attempt to reach a predetermined number of tablets.

Most importantly, do not stop a prescribed medicine because an interaction checker, article or social-media post frightened you.

Potential interactions vary enormously in clinical importance. Doctors sometimes prescribe interacting medicines deliberately because the expected benefit outweighs the risk, with dose adjustment or monitoring where appropriate.

Pakistan has a system for reporting suspected reactions

Medication safety is not solely an American issue.

Pakistan’s Drug Regulatory Authority of Pakistan operates a National Pharmacovigilance Centre for monitoring suspected adverse reactions to medicines and other therapeutic goods.

DRAP says patients and consumers can report suspected side effects. Its guidance asks for information about the medicine involved, dose, timing, other medicines being taken and relevant medical conditions.

That last detail matters.

A suspected reaction cannot be understood properly if nobody knows what else the patient swallowed.

DRAP reported in its MedSafetyWeek material that its National Pharmacovigilance Centre had received and processed more than 30,000 reports since 2018. That figure covers suspected medicine-safety reports generally and should not be confused with the US interaction figures in the JAMA study.

Different system. Different population.

The principle, however, travels well: unexplained adverse effects deserve investigation and reporting rather than assumption.

The doctor may know every medicine and still miss the complete picture

Modern medicine has become increasingly specialised.

A cardiologist may manage the heart. Another physician manages diabetes. A different doctor treats pain or depression.

Each can prescribe rationally within a particular field.

The patient remains the only person standing at the intersection of all those prescriptions.

That is why medication reconciliation matters so much.

The danger does not require a careless doctor. It can emerge from a fragmented system in which each prescription makes sense separately while nobody has recently examined the entire combination.

Then the patient adds an OTC painkiller.

Perhaps a supplement enters the cupboard.

Nothing dramatic happens that evening. Months pass.

The risk remains invisible because the medicine cabinet looks ordinary.

My medicine cabinet now looks different to me

The new JAMA study does not tell older people to fear medicine.

I take almost the opposite lesson from it.

Modern medicines allow millions of people to control illnesses that once shortened lives much earlier. Blood-pressure treatment prevents strokes. Diabetes medicines reduce complications. Cardiovascular drugs save lives.

Ageing successfully may therefore require more medicine, not less.

But more medicine creates another responsibility.

Every so often, someone needs to look at the complete list.

Not only the cardiologist’s medicines. Not only the latest prescription. Not merely the tablets we personally consider important.

Everything.

The most useful health check after 60 may occasionally begin without a blood test or scan.

It may begin with a sheet of paper and a surprisingly simple question:

“Do I still need all of these, together?”

Medical note: This article provides general health information and does not replace individual medical advice. Never stop, start or change the dose of a prescribed medicine without consulting an appropriate healthcare professional.

Can Lifestyle Changes Slow Muscle Loss as We Age? What the Evidence Says About Sarcopenia

Age-related muscle loss is not inevitable at a fixed rate. Current evidence shows how resistance training, adequate nutrition and earlier attention to muscle health can help preserve strength and function as we age.

I notice muscle loss most clearly in ordinary movements. A staircase feels steeper. Rising from a low chair takes a little more effort. A shopping bag that once seemed light suddenly asks more from the arms. None of these changes proves that a person has sarcopenia, but they point toward something we often underestimate: ageing is not only about wrinkles or grey hair. It also changes the machinery that keeps us independent.

The encouraging part is that the decline is not completely fixed. Lifestyle cannot stop biological ageing, and it cannot guarantee that sarcopenia will never develop. Yet exercise and adequate nutrition can materially influence muscle strength and function. The strongest evidence points to resistance training, supported by sufficient food and protein.

Muscle loss is not simply a number on the scale

Sarcopenia is a progressive disorder involving skeletal muscle. Older explanations often treated it mainly as a loss of muscle mass. Clinical thinking has changed. The European Working Group on Sarcopenia in Older People placed particular emphasis on low muscle strength, using low muscle quantity or quality to confirm the diagnosis and poor physical performance to indicate severe disease.

That distinction matters. A bathroom scale cannot tell us whether an older person can rise safely from a chair or recover balance after a stumble. Two people of similar weight may have very different levels of muscle strength. Muscle health is about what the body can do, not simply how much it weighs.

The Asian Working Group for Sarcopenia 2025 consensus update pushes the argument further. It adopts a life-course approach to muscle health and extends diagnostic consideration into middle age, including adults aged 50 to 64. Its framework requires concurrent low muscle mass and low muscle strength for sarcopenia, while physical performance is treated as an outcome measure. For Asian readers, this is an important shift. Muscle health deserves attention before someone reaches old age.

Why I would remove the old percentage rules

Older health articles often say that people lose a fixed percentage of muscle or strength every year after middle age. Such figures are attractive because they are easy to remember. They are also easy to misuse.

Age-related decline varies considerably. Physical activity matters. Illness, periods of bed rest and nutritional status can alter the trajectory. The method used to measure muscle also changes the result. A universal annual percentage can therefore make normal ageing sound like a timetable.

Modern diagnostic frameworks do not decide that a person has sarcopenia because he or she has reached a certain birthday or supposedly lost a predetermined percentage of muscle. Clinicians use measures such as grip strength, chair-stand performance and assessments of muscle quantity according to the relevant framework. The important question becomes more practical: is muscle strength or mass low enough to affect health and function?

Resistance training has the strongest case

If I had to identify the central correction to the old article, it would be this: general advice to “stay active” is not specific enough. Walking is valuable. It supports cardiovascular health and mobility. But walking and resistance training do not place the same demand on muscle.

The International Clinical Practice Guidelines for Sarcopenia strongly recommend resistance-based physical activity for treatment. A later review of resistance-exercise prescription explains the importance of progressive overload: muscle must face an appropriate resistance and, as capacity improves, the challenge must progress. Resistance can come from weights, machines, elastic bands or body weight.

This does not mean an older beginner should walk into a gym and immediately lift heavy weights. Technique matters. So does progression. A person who has been inactive, has significant joint problems or lives with cardiovascular or other chronic disease may need professional advice before increasing exercise intensity.

Simple movements can still be meaningful. Repeated chair stands train muscles used every time we get up. Resistance-band exercises can provide load without a large home gym. The objective is not bodybuilding. It is preserving enough strength to continue doing ordinary things without unnecessary dependence.

Walking still matters, but it does a different job

I would not tell an older reader to abandon walking. That would miss the wider health picture. Regular walking supports endurance and daily mobility, while physical activity helps counter the inactivity that often accelerates functional decline.

But a daily walk should not automatically be treated as a complete muscle-preservation programme. If the goal includes maintaining strength, some form of progressive resistance exercise deserves a place alongside aerobic activity. The distinction is especially important for people who assume that being generally busy around the house provides all the muscular stimulus they need.

Protein helps, but more is not automatically better

Muscle also needs nutritional support. Protein provides amino acids used in muscle protein synthesis, and inadequate food intake can become a serious problem in older age. Appetite may fall. Dental problems or illness can reduce intake. Someone may therefore be losing weight and muscle without deliberately dieting.

The Asian Working Group for Sarcopenia’s nutrition consensus emphasizes adequate nutrition as part of muscle-health management. Evidence also suggests that combining resistance exercise with protein support can improve muscle outcomes in people with sarcopenia. A systematic review and meta-analysis of community-dwelling older adults found improvements in muscle mass and strength when protein supplementation was combined with resistance exercise, although the authors noted the limited number of trials.

Protein advice still needs context. Requirements vary with body size, total diet and medical circumstances. Kidney disease is one reason not to turn a population recommendation into a personal high-protein prescription without medical advice. Supplements can be useful in selected cases, but ordinary protein-rich foods may already provide what many people need.

The real danger may be the inactivity cycle

Muscle loss can become self-reinforcing. A person feels weaker, so movement becomes uncomfortable. Activity then falls. Lower activity gives the muscles less reason to remain strong, and daily tasks can become harder still.

Illness can accelerate the problem. A hospital admission or a prolonged period in bed can remove much of the normal loading that muscles receive during daily life. Recovery should therefore concern function as well as the disease that caused the admission. Being medically stable is not always the same as having regained previous physical capacity.

The latest 2026 rehabilitation guideline for older adults with sarcopenia reflects this broader approach. It covers assessment and prevention as well as exercise and nutrition, underlining that sarcopenia management is not a single-food or single-exercise problem.

Middle age is a better time to think about muscle

I find the 2025 Asian consensus particularly useful because it changes the timing of the conversation. We should not wait until an older person is visibly frail before discussing muscle health. The inclusion of ages 50 to 64 in the updated framework recognizes that the foundations of later-life function are built earlier.

For someone in middle age, the practical lesson is not to become anxious about every change in strength. It is to treat muscle as an organ worth maintaining. Regular resistance exercise becomes part of preventive health rather than a cosmetic project.

When weakness deserves medical attention

Not every case of weakness is sarcopenia. Sudden or marked weakness can have other causes, and unexplained weight loss deserves assessment. Repeated falls, increasing difficulty rising from a chair or a clear decline in walking ability should not simply be dismissed as “getting old.”

A clinician can look for contributing illness and review nutrition, medications and physical function. Formal sarcopenia assessment may include strength testing and measurement of muscle mass. The purpose is not to attach a frightening label. It is to identify a potentially modifiable problem before loss of function becomes harder to recover.

Age changes muscle, but age does not write the whole story

The old way of describing sarcopenia made ageing sound almost mechanical: reach a certain age, lose a predictable percentage of muscle, then accept the decline. The evidence now gives us a more useful picture.

Age matters, but so does the stimulus we give our muscles. Resistance training can improve strength and physical function, while adequate nutrition supports the biological work behind those adaptations. Neither is a guarantee against sarcopenia. Both give people something practical to act on.

I return to the staircase. The aim is not to make a 70-year-old body behave as if it were 30. It is to preserve enough strength for that staircase, that chair and the ordinary movements that keep life independent. Muscle health is built quietly, long before we notice how much we need it.

Medical note: This article provides general health information and is not a substitute for individual medical advice. People with chronic disease, significant mobility limitations or unexplained weakness should discuss major changes in exercise or diet with an appropriate healthcare professional.