Trends and Characteristics of Medication Use Among U.S. Older Adults by Frailty - 20-Year NHANES Analysis

Sep 28, 2026

Frailty, a syndrome of reduced physiologic reserve, is linked to greater medication burden and heightened vulnerability to adverse drug events. Understanding which therapeutic classes predominate—and how their distribution differs by frailty status—has been limited by long-term, population-based evidence. Using U.S. NHANES data from 1999 to March 2020, the analysis evaluated adults aged 65+ (n=12,766) with available frailty index components, comparing robust, frail, and severe frailty groups across survey years.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

Abstract

Data source and design

Medication counts across frailty status

Therapeutic class patterns

Implications for medication optimization

1206 Innovation in Aging, 2025, Vol. 9, No. S2 Abstract citation ID: igaf122.4036 TRENDS AND CHARACTERISTICS OF MEDICATION USE AMONG U.S. OLDER ADULTS BY FRAILTY: A 20-YEAR NHANES ANALYSIS Maryanne Kim, Michael Steinman, and Matthew Growdon, University of California, San Francisco, San Francisco, California, United States Frailty, a syndrome of reduced physiologic reserve, is associated with higher medication burden and vulnerability to adverse drug events. Reducing this burden requires understanding which therapeutic classes predominate and how their distribution varies by frailty status; however, long-term, population-based data remain limited. We analyzed data from the U.S. National Health and Nutrition Examination Survey (NHANES), 1999–March 2020, including 12,766 adults aged ≥65 years with ≥80% of frailty index (FI) components available, categorizing participants as robust, frail or severe frailty. Trends in therapeutic class use were examined across survey years. Mean medication counts rose from 2.60 to 3.52 in robust, 4.23 to 5.66 in frail, and 6.08 to 7.87 in severe frailty. Cardiovascular and metabolic agents predominated in all frailty groups, with higher counts in more frail groups. By 2017–2020, older adults with severe frailty used more than twice as many drugs from cardiovascular (2.59 vs 1.02) and metabolic (1 . 88 vs 0 . 81) classes as robust individuals. Over the 21-year period, the use of psychotherapeutic agents rose in all groups, nearly quadrupling in people with severe frailty (0.09 to 0.38), while central nervous system agents use increased minimally in robust and frail groups but meaningfully in severe frailty group (0.66 to 0.90). Medication burden increased across all frailty strata, with severe frailty showing higher use of cardio-metabolic agents and larger increase in psychotherapeutic and central nervous system agents. Medication optimization strategies for older adults should be tailored to frailty status, with attention to therapeutic classes most likely to drive polypharmacy.

FAQs

What relationship does the study describe between frailty and medication burden?

Frailty is associated with higher medication burden and greater vulnerability to adverse drug events.

Which data set and time span were used for the 20-year analysis?

The study used U.S. National Health and Nutrition Examination Survey (NHANES) data from 1999 to March 2020.

How did medication counts change across robust, frail, and severe frailty groups?

Mean medication counts increased over time and were highest in the severe frailty group, reaching 6.08 to 7.87 versus 2.60 to 3.52 in robust participants.

Sep 28, 2026

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