GLP-1 Medications for Adults 65+: Complete Guide

What the Clinical Trials Tell Us About Seniors

The good news: older adults weren't excluded from major GLP-1 trials. The SELECT trial—the largest cardiovascular outcomes study for obesity (17,604 patients)—enrolled participants aged 45-75, with a mean age of 61.6 years. Roughly half the participants were over 60, giving us robust data on this population.

The FLOW trial, which studied semaglutide for kidney protection in type 2 diabetes patients, had a mean participant age of 66.6 years. This trial demonstrated a 24% reduction in major kidney events and a 20% reduction in all-cause death—proving GLP-1s offer meaningful benefits for older adults with chronic kidney disease.

How Effective Are GLP-1s in Older Adults?

Weight loss efficacy appears similar across age groups, though some nuance exists. In the STEP trials, participants 65+ achieved weight loss outcomes comparable to younger cohorts—roughly 14-16% reduction in body weight over 68 weeks.

However, the clinical context differs. For a 70-year-old, the goal may not be maximum weight loss but rather cardiovascular risk reduction, improved mobility, or better diabetes control. The cardiovascular and kidney protection benefits—which don't require massive weight loss—become increasingly valuable with age.

The Muscle Loss Problem: Why It Matters More After 65

This is the most important consideration for older GLP-1 users. When anyone loses weight rapidly—whether through medication, surgery, or dieting—a significant portion of that weight comes from lean mass (muscle).

How to Preserve Muscle While on GLP-1s

The research is clear: resistance training and adequate protein intake can substantially reduce lean mass loss during GLP-1 therapy.

If appetite suppression makes it difficult to eat adequate protein, some clinicians recommend protein supplements or meal timing strategies (eating protein-rich foods earlier in the day when appetite is higher).

Fall Risk: A Serious Consideration

Rapid weight loss affects balance and coordination, and this matters more for older adults. Weight loss changes your center of gravity, and if muscle mass declines faster than your nervous system adapts, fall risk increases.

The research hasn't quantified this precisely for GLP-1s, but post-bariatric surgery data—where weight loss is more rapid—shows increased fall rates in the first year. Given that falls are a leading cause of disability in adults 65+, this warrants proactive attention.

Kidney Function Considerations

Kidney function naturally declines with age, and many older adults have some degree of chronic kidney disease (CKD). Here, GLP-1s may actually be beneficial.

No dose adjustment is required for semaglutide or tirzepatide in mild-to-moderate CKD. However, dehydration from GI side effects can acutely worsen kidney function, so hydration is particularly important for older adults with baseline kidney impairment.

Polypharmacy: Drug Interactions in Older Adults

Adults 65+ typically take multiple medications, raising drug interaction concerns. GLP-1s delay gastric emptying, which can affect absorption of oral medications.

The most clinically significant interaction is with glucose-lowering medications. Older adults on insulin or sulfonylureas starting a GLP-1 need proactive dose reductions to prevent hypoglycemia.

Titration: Go Slower Than Standard

GLP-1 manufacturers provide standard titration schedules, but older adults often do better with extended timelines. GI side effects (nausea, vomiting, diarrhea) can be more problematic in seniors due to dehydration risk and medication compliance.

Frailty Screening: Who Shouldn't Use GLP-1s?

GLP-1s are not appropriate for all older adults. Frail individuals—those with significant functional impairment, unintentional weight loss, or sarcopenia—may be harmed by further weight loss.

Some geriatricians use the FRAIL scale or Clinical Frailty Scale before prescribing weight-loss medications. If frailty is present, the cardiovascular benefits of GLP-1s (independent of weight loss) might still apply, but at lower doses with careful monitoring.

What About Adults 75+?

Most clinical trials excluded patients over 75, so data is limited. The SELECT trial capped enrollment at 75 years. This means we're extrapolating from the 65-75 cohort when treating older patients.

Clinical considerations intensify after 75:

• Muscle mass preservation becomes even more critical
• Fall risk is higher baseline
• GI side effects may be less tolerated
• Benefit-risk calculation shifts toward cardiovascular protection over weight loss
• Shared decision-making with patient and family is essential

For adults 75+, if GLP-1 therapy is pursued, the focus should be on low-dose therapy with cardiovascular or metabolic goals rather than aggressive weight loss.

Cost and Access for Medicare Patients

Medicare Part D does not currently cover GLP-1s for weight loss (obesity indication). Coverage is available only for the diabetes indication (Ozempic, Mounjaro). This creates a significant barrier for older adults without diabetes.

However, policy is shifting. The CMS BALANCE Model announced in late 2025 aims to expand Medicare/Medicaid access to GLP-1s with lifestyle support. For now, options include:

• Manufacturer savings programs (limited for Medicare patients due to anti-kickback rules)
• Compounded semaglutide (availability restricted after Feb 2025 shortage resolution)
• Clinical trials for eligible patients
• If diabetic, pursuing coverage under diabetes indication