The research was led by Dima Mazen Qato of the USC Mann School of Pharmacy and Pharmaceutical Sciences and the USC Schaeffer Center for Health Policy & Economics, in collaboration with researchers from the Johns Hopkins Bloomberg School of Public Health and NORC at the University of Chicago.

Using nationally representative data from nearly 5,000 community-dwelling U.S. adults ages 62 to 85, researchers compared medication and supplement use in 2015–2016 with use in 2021–2023.

They found that polypharmacy, defined as taking five or more prescription medications at the same time, increased from 31% to 35.7%. Dietary supplement polypharmacy also increased, from 12.6% to 16.7%.

The concurrent use of drug regimens with potentially major interactions declined from 25.7% to 22.3%. However, the therapeutic classes most frequently involved in these regimens remained largely unchanged. In 2021-23, more than 1 in 5 older adults were taking medications that placed them at risk for a potentially major drug interaction.

Antidepressants, statins and antiplatelet therapies were the most commonly used medications involved in potentially major interactions among older adults.

“These findings underscore the need for continuing efforts to improve medication safety among older adults,” Qato said. “Efforts to reduce polypharmacy and harmful drug interactions should focus on commonly used interacting regimens, particularly those involving antidepressants.”

The study’s co-authors are Shyam Krishnan Ondanat Veetil and Qingrong “Jessica” Li of USC Mann; Jocelyn Wilder of NORC at the University of Chicago; and Rupshikha Sen and G. Caleb Alexander of the Johns Hopkins Bloomberg School of Public Health.

The study used data from the National Social Life, Health and Aging Project, which is supported by the National Institute on Aging (R01AG043538).

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Overall, 443 participants aged ≥65 years who use ≥5 drugs regularly were included. At the end of the trial, fewer patients in the medication review group had potentially inappropriate prescriptions compared with patients in the usual care group (29.9% versus 70.8%). Likewise, there was less medication overuse (34.2% versus 64.1%) and medication underuse (44.9% versus 73.2%). Furthermore, 337 missing vaccinations (against influenza, pneumonia, COVID-19, and/or shingles) were recommended in the medication review group.

“The pharmacist-led comprehensive medication review to counsel physicians in oncological rehabilitation wards was highly feasible and substantially improved the medication quality of older cancer patients with polypharmacy,” said corresponding author Ben Schöttker, PhD, of the German Cancer Research Center.

URL upon publication: https://onlinelibrary.wiley.com/doi/10.1111/joim.70161

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This means more emergency department visits, more frequent and longer hospitalizations, poorer mental health and greater risk of premature death.

However, there is a sliver of good news. The number of older adults who took medications that may impair cognition declined significantly between 2011 and 2022, according to a recent study conducted by researchers at the University at Buffalo.

They examined data from 2,796 older adults with cognitive disorders who were living independently. Their exposure to these inappropriate drugs dropped from 39.3% in 2011 to 29.3% in 2022.

“This is a population with some mental issues that relate to the central nervous system. These drugs also act on the central nervous system, so they can be too much for older adults if inappropriately used,” says Haowen Hsu, PharmD, postdoctoral fellow in the Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences. He is the first author of the study that was published Aug. 4 in the Journal of the American Geriatrics Society.

The importance of ‘deprescribing’ drugs

For instance, a patient who has been treated for anxiety for years with a benzodiazepine, such as Xanax, or a sleep aid, such as Ambien, may need to be weaned off or prescribed a smaller amount because these drugs can impair balance, coordination and cognition.

“A central word for patients in this age group is ‘deprescribing,’ which means, for example, removing inappropriate medications and decreasing the frequency or the dosage. In some cases, it means replacing the current medication with a milder alternative,” Hsu says. “This is why it’s so important for health care providers to work closely with community pharmacists and homecare nurses to optimize medication safety.”

The researchers started with the American Geriatric Society’s Beers Criteria, a list of some 100 medications that can be harmful to older adults. Then they narrowed the focus – looking specifically at adults who have been diagnosed with a cognitive disorder to figure out additional risks.

The study participants, whose data came from a Medical Expenditure Panel Survey, represent approximately 29.7 million older Americans with cognitive disorder across 2011-2022. Hsu and the team compared people who had been prescribed at least one of these potentially problematic medications with those who had not.

While the researchers didn’t investigate reasons behind the drop in exposure to the drugs, Hsu says that over the past two decades, both clinicians and researchers have paid more attention to medications for older adults. And this slow but consistent change likely reflects ongoing efforts in geriatric care and medication safety.

“We were happy to see the percentages of harm decline over that 11-year period,” he says. “However, one-third of our target population is still exposed to these harmful medications, which isn’t good.”

Connection to Team Alice initiative

Indeed, older adults in general are susceptible to drug interference or inappropriate prescriptions, sometimes resulting in higher mortality rates, as examined in UB’s larger interdisciplinary, ongoing initiative Team Alice.

The initiative was named after Alice Brennan, who died in 2009 after being prescribed a muscle relaxant medication that is recognized on the Beers Criteria as being inappropriate. The health care system failed to recognize the error, and she died after six weeks of avoidable complications. Alice’s daughter, Mary Brennan-Taylor, brought her mother’s story to UB researchers looking to drive systemic change to protect others from harm.

Hsu started this current study soon after he joined the pharmacy school and Team Alice to work in the UB Patient Safety Learning Laboratory.

“This work extends a series of national analyses our group has published on potentially inappropriate medications, quality of life, and health care use in older adults,” says David Jacobs, PharmD, PhD, associate professor of pharmacy practice who is a principal investigator on Team Alice.

“It is especially important as older adults with cognitive disorders are the least able to tolerate medications that worsen memory or thinking, yet nearly one in three are still receiving them. Most of these patients have a regular source of care so these medications can be identified and addressed with their care team.”

Along with Jacobs, Team Alice’s co-principal investigators Ranjit Singh, MD, associate professor and interim chair of the Department of Family Medicine in the Jacobs School of Medicine and Biomedical Sciences at UB, and Robert Wahler, PharmD, clinical associate professor of pharmacy practice, contributed to the study. Other contributors include Collin Clark, PharmD, clinical associate professor of pharmacy practice, and Steven Feuerstein, information systems analyst in the Jacobs School.

Along with highlighting the importance of careful medication reviews during outpatient visits, this study suggests integrating clinical assessment tools in acute care and ambulatory settings, such as the Drug Burden Index, to evaluate the cumulative burden of central nervous system-active medications and help reduce potentially preventable harm.

And finally, it recognizes the need for additional studies to determine whether strategies to optimize medication use can improve the quality of life and reduce hospitalizations and emergency room visits for older adults with cognitive issues.

Number of older adults now exceeds share of young children

Their findings come at an auspicious time. The U.S. Census Bureau just reported that for the first time in human history, people age 65 and older worldwide outnumber children from infancy to age 5.

Living longer, however, doesn’t necessarily mean additional healthy years. This same report notes that almost 75% of adults 65 and older live with two or more chronic health issues. And more conditions lead to more medications, some of which can be harmful to aging bodies and brains.

“This is an issue that has been building for decades, but the growth of the older adult population has arrived sooner than we expected,” Hsu says. “This means that health care professionals need to pay closer attention than ever to medication safety, especially for older adults experiencing cognitive decline or other complex health concerns.”

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The research was presented by Dr Lisa Steen Duus from Gentofte Hospital, Copenhagen, Denmark. She said: “Flu can be particularly serious for older people with chronic lung disease, such as asthma and COPD. They are more likely to develop complications, including pneumonia, worsening of their existing lung disease, and hospitalisation.

“Although high-dose flu vaccines are designed to produce a stronger immune response in older adults, there has been limited randomised evidence specifically showing whether they provide better protection against serious illness in people with chronic lung disease. We therefore wanted to investigate whether a high-dose vaccine could reduce hospitalisations in this particularly vulnerable group.”

The new research combines the results of two gold-standard randomised controlled trials comparing a high-dose flu vaccine with a standard-dose in people aged 65 and older. One trial ran in Denmark over three flu seasons (2022-23, 2023-24 and 2024-25) and one ran in Galicia, Spain over two flu seasons (2023-24 and 2024-25). Analysis of these trials has already shown that the high-dose vaccine is beneficial in older people overall [2].

In the new study, researchers looked specifically at trial participants who had a chronic lung disease, including asthma, bronchiectasis, bronchitis, chronic obstructive pulmonary disease (COPD), cystic fibrosis, emphysema, interstitial pulmonary disease, lung transplantation, respiratory tuberculosis and sarcoidosis. Between the two studies, this was 31,976 people, just under seven per cent of the total 466,320 trial participants.

Around half of the participants were randomly allocated to receive a standard dose of flu vaccine. The other half received a flu vaccine containing four times as much of the active ingredient that stimulates the immune response.

Researchers monitored the participants and recorded any who were hospitalised from 14 days after their vaccination until the following May when the flu season is largely over in Europe.

The high-dose flu vaccine reduced hospital admissions for flu or pneumonia by 8.8% compared with the standard-dose vaccine. The high-dose vaccine also reduced hospitalisations for several other conditions, including cardiorespiratory disease, and hospitalisation from any cause, compared to the standard-dose vaccine.

Dr Duus said: “For older people with chronic lung disease and their families, these findings provide reassurance that high-dose flu vaccination can offer better protection against serious illness requiring hospital treatment than a standard-dose vaccine.

“Being hospitalised creates a considerable burden on patients, families and healthcare systems, so even a modest reduction could have meaningful public health benefits. For that reason, these results support considering high-dose flu vaccines for older adults, including those with chronic lung disease, when developing vaccination recommendations.”

Professor Thomas Wilkinson, Chair of the European Respiratory Society’s Group on Respiratory Infections and Immunology and based at University of Southampton, UK, who was not involved in the research said: “A flu infection is unpleasant for anyone, but for some people it can be a serious health risk. Older people with lung disease have a greater risk of severe illness, hospitalisation and death from flu, which is why the European Respiratory Society recommends annual flu vaccination for this group.

“This research combines the results of two large and well-run studies comparing the standard-dose flu vaccine with a high-dose flu vaccine in people aged 65 and above. Researchers have looked specifically at people on the trial who had also been diagnosed with a lung disease, such as COPD or asthma. Their analysis shows that a high-dose flu vaccine could be even more beneficial in this group.”

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Q: What challenges or unmet needs make this study important?

Survival among people with HIV in the United States continues to improve due to highly effective antiretroviral therapy (ART), a lifelong treatment. As a result, costs to Medicare are expected to rise substantially as more adults with HIV live long enough to age into the program. However, it’s been largely unknown just how extensive the increase in Medicare beneficiaries may be over the next decade and how much the program’s spending could rise.

Q: What central question(s) were you investigating?

Our team used simulation modeling to answer these three main questions:

• Over the next decade, how many people with HIV (who are receiving HIV care) over the age of 65 are likely to be enrolled in Medicare?
• How much is Medicare estimated to spend on this population over this time period?
• How might policies or strategies to reduce the cost of ART impact these projections?

Q: What methods or approach did you use?

We developed and populated a new model called CHARMED with projections from the previously validated CEPAC model, Medicare claims data, and publicly available data. Our aim was to simulate a population of Medicare beneficiaries with HIV, aged 65+ and being treated with ART, and their associated costs.

To address uncertainty in model estimates and trends, we examined scenarios where the size and associated costs of this group varied—for example, by assessing the potential impact of policies to reduce the cost of ART. Such policies included the Inflation Reduction Act (IRA), which allows Medicare to negotiate the cost of Biktarvy, the most prescribed ART regimen in the United States, with lower prices to take effect in 2028. Additionally, generic dolutegravir is expected to become available in 2031, thereby enabling a highly effective, well-tolerated, fully generic ART regimen.

Q: What did you find?

Our projections show that nearly 122,000 older adults receiving HIV care may be enrolled in Medicare by the end of 2026—a number that may increase to about 193,600 by the end of 2035. We also estimated that annual Medicare spending for this population may increase from $10.9 billion at the end of 2026 to $27.3 billion at the end of 2035.

Cumulative 10-year costs may reach $187.2 billion, with 63% attributable to ART costs alone. If ART costs were reduced by 60%, Medicare could potentially save $70.3 billion over the next decade. Moreover, if current prescribing patterns remain unchanged, policies such as the IRA and the availability of generic HIV medications could save Medicare approximately $19 billion between 2026 and 2035.

Q: What are the real-world implications, particularly for patients?

Our findings demonstrate that the number of older adults living with HIV is likely to increase substantially over the next decade, driving up Medicare enrollment. Clinicians and healthcare systems must be prepared to address the medical needs of this growing population through comprehensive, person-centered care—especially given these individuals’ increased risk of comorbidities and polypharmacy (taking several medications regularly).

We also conclude that policymakers for Medicare and other public programs will likely seek out ways to reduce the cost of HIV care. While recent proposals have included higher Medicare premiums, drug coverage reductions, and stricter eligibility for drug assistance programs, our paper points to other promising strategies to reduce ART costs without increasing patient costs or limiting access.

Authorship: In addition to Hyle and Freedberg, Mass General Brigham authors include Luke Ang, Grace Luu, Florence Ebem, Satoshi Koiso, Paul E. Sax, John Giardina, E. John Orav, Anne M. Neilan, and Jose F. Figueroa. Additional authors include Parastu Kasaie, Dannie Dai, Jessica Phelan, Ciara Duggan, Elizabeth Humes, Dori Molozanov, Lucas Gerace, Tim Horn, Ankur Pandya, and Keri N. Althoff.

Paper cited: Hyle, EP., et al. “Ten-Year Cost Projections for Medicare Beneficiaries 65 Years or Older with HIV.” JAMA Network Open. DOI: 10.1001/jamanetworkopen.2026.21966

Funding: This research was funded by the National Institutes of Health (R01 AG069575, R01 AI042006, R01 AG081151, U01 AI069918, R01 AG053100, R01 AI179776) and the Massachusetts General Hospital Jerome and Celia Reich HIV Scholar Award.

Disclosures: Hyle, Humes, Giardina, Neilan, Figueroa, Althoff and Freedberg reported receiving grants from the National Institute of Health (NIH).

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“Our results showed that discharging older adults after an acute care hospital stay with a new prescription for these medications was associated with an increased hazard of falls requiring medical attention, further need for acute hospital care, and death in the 30 days after hospital discharge, whereas individuals with prior exposure did not experience the same increased hazards,” writes Dr. Lisa Burry, clinician scientist at Mount Sinai Hospital, Sinai Health and University of Toronto, Toronto, Ontario, with coauthors.

Falls are a major public health burden and affect older adults in particular. Sedatives and antipsychotics are associated with adverse events, and clinical guidance discourages prescribing these potentially inappropriate medications for older adults.

The study of more than 1.86 million adults aged 66 years and older aimed to understand prescribing patterns to inform discharge prescribing in future. Based on ICES data, it looked at all patients discharged from hospital between April 2003 and August 2023. In total, 13% (246 440) filled at least 1 prescription for any sedative within 7 days of discharge, and about one-third (76 335) of them had not filled a prescription for a sedative within the 6-month period before hospitalization. The risk of falls was 20% higher in people with a new sedative prescription, and the risk of an emergency department visit, readmission, and death within 30 days was also increased.

“Although the overall absolute magnitude of the risk of adverse events identified was modest from a population perspective, the effects on patients and their families are clinically and socially important,” write the authors. “Moreover, given the volume of hospital admissions among older adults and the aging population, a modest increase in risk translates into a large impact on the health care system.”

The authors suggest caution when prescribing these medications on hospital discharge, ensuring medical follow-up 1 to 2 weeks after discharge to monitor patients, continue risk assessment, and review the need for the prescription.

“Given the identified associations, clinicians must consider whether new sedative prescriptions are essential or can be deprescribed or de-escalated before or shortly after hospital discharge. When ongoing sedative use is required, community support, such as falls or mobility assessments, and ongoing medication reviews may help mitigate risks,” the authors conclude.

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The researchers analysed Finnish national registry data on 209,346 older adults living at home who did not have Alzheimer’s disease. They compared three groups: off-label users, people taking antipsychotics for an official indication, and those not using the medications at all.

The results were striking: 70 percent of all antipsychotic use fell into the off-label category. Use of these medications off-label also increased over the course of the study period. Risperidone and quetiapine were the most commonly used antipsychotics off-label.

Physicians often prescribe antipsychotics to older patients to manage prolonged behavioural symptoms or insomnia, despite the absence of official approval for these conditions. Previous research has even suggested that using these drugs without alternative non-drug treatments can constitute a form of elder abuse. Limited resources in elderly care and a lack of non-pharmacological options appear to have contributed to the growing use of these medications.

The study found that off-label users were more likely than other groups to have cardiovascular diseases and cerebrovascular disorders. They were also more likely to be using opioids.

“Surprisingly, off-label users had cardiovascular and cerebrovascular conditions even more frequently than patients prescribed antipsychotics for an approved indication, such as psychotic disorders,” said postdoctoral researcher Tuomas Majuri of the University of Oulu.

Majuri noted that this finding could reflect insufficient monitoring of the metabolic side effects of these medications when used off-label.

The researchers say their findings underscore the need for alternative treatments for symptoms currently managed with off-label antipsychotic use.

“Clearer guidelines are needed for monitoring metabolic side effects, and measures must be taken to promote safer prescribing practices,” Majuri added.

The study was funded by the Päivikki and Sakari Sohlberg Foundation and the Research Council of Finland.

Article: Majuri T*, Silvan J*, Tolppanen A-M, Hartikainen S, Huotari T, Rautio N, Miettunen J, Nordström T, Jääskeläinen E, Haapea M. Characteristics and predictors of antipsychotic medication off-label use among community-dwelling older people. Nord J Psychiatry 2026. Published online 16 Feb 2026.

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The study, titled “Sodium-Glucose Cotransporter-2 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, and Frailty Progression in Older Adults With Type 2 Diabetes,” and published in Diabetes Care, looked at older adults who had just started different types of diabetes medications and followed them for one year. They found that people taking SGLT-2 inhibitors or GLP-1 drugs were less likely to show signs of frailty, such as weakness, slowed movement, or fatigue, compared with those starting other diabetes medications. In other words, these treatments appeared to help patients with diabetes maintain strength and function as they aged. The benefit could not be fully explained by heart benefits, suggesting the medications may directly help protect against frailty.

Analyzing a national 7% sample of U.S. Medicare claims, researchers tracked one-year changes in a validated claims-based frailty index (CFI; range 0–1, with higher scores indicating greater frailty). Compared with new users of DPP-4 inhibitors, those starting GLP-1 receptor agonists saw a mean CFI change of –0.007 (95% CI: –0.011 to –0.004) and those starting SGLT-2 inhibitors saw a mean change of –0.005 (95% CI: –0.008 to –0.002), indicating slower frailty progression. Users of sulfonylureas showed no significant difference. Additional analyses found that cardiovascular or other safety events accounted for only a small portion of the effect, suggesting a potential direct benefit of these medications on frailty itself.

According to prior research, roughly 10–15% of adults over age 65 experience frailty, with higher rates in those with type 2 diabetes. People with diabetes are particularly at risk due to chronic inflammation, muscle loss, cardiovascular disease, and the cumulative burden of managing a complex condition. Frailty is associated with falls, disability, hospitalization, and reduced lifespan. Because it is difficult to reverse once established, slowing frailty progression has emerged as an important goal in geriatric care, making the findings of this study especially significant for older adults with diabetes.

“While SGLT-2 inhibitors and GLP-1 receptor agonists are primarily prescribed for blood sugar control and heart protection, our findings show they may also help older adults with diabetes stay stronger and less vulnerable to health setbacks,” said lead author of the study, Chanmi Park, MD, MPH, Assistant Scientist I, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife. “Because frailty is common, serious, and hard to reverse, this could meaningfully change how clinicians think about medication choices for aging patients.”

In addition to Park, the other researchers were Saran Thanapluetiwong, MD, Visiting Research Fellow, Marcus Institute for Aging Research, Hebrew SeniorLife; Xiecheng Chen, PhD, Data Scientist I, Marcus Institute for Aging Research, Hebrew SeniorLife; Gahee Oh, MD, MPH, Daa Scientist II, Marcus Institute for Aging Research, Hebrew SeniorLife; Darae Ko, MD, MSc, Associate Scientist, Marcus Institute for Aging Research, Hebrew SeniorLife; and Dae Hyun Kim, MD, MOH, ScD, Associate Director & Senior Scientist, Marcus Institute for Aging Research, Hebrew SeniorLife.

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Tramadol is an opioid used to treat moderate to severe pain in adults. Some antidepressants that inhibit the CYP2D6 enzyme, called CYP2D6 inhibitors, can interfere with how the body metabolizes tramadol. When the CYP2D6 enzyme is blocked, tramadol is not metabolized properly and may build up in the body, potentially increasing the risk of side effects like seizures. Common CYP2D6-inhibiting antidepressants include fluoxetine, paroxetine and bupropion.

“We found a modest but measurable increase in the risk of seizures when tramadol was taken with antidepressants that inhibit the CYP2D6 enzyme,” said study author Yu-Jung Jenny Wei, PhD, of The Ohio State University in Columbus. “This risk was consistent whether the antidepressant or tramadol was started first.”

Researchers analyzed 10 years of Medicare data to identify 70,156 nursing home residents age 65 and older who had been prescribed both tramadol and an antidepressant.

They divided participants into two groups based on which drugs they took first. Of participants, 11,162 people took tramadol first and then an antidepressant with it, while 58,994 people took an antidepressant first and then added tramadol.

Seizure rates for people who took tramadol first were 16 seizures per 100 person-years, and for people who took antidepressants first, the rate was 20 seizures per 100 person-years. This means for every 100 people who used both tramadol and an antidepressant followed for one year, about 16 or 20 received a seizure diagnosis.

In both groups, researchers then compared seizure rates between those who took tramadol with CYP2D6-inhibiting antidepressants and those who took tramadol with antidepressants that do not inhibit the enzyme. In those who took tramadol first and added an antidepressant, the rate was 18 seizures per 100 person-years for those taking CYP2D6-inhibiting antidepressants compared to 16 seizures per 100 person-years in people taking other antidepressants. In those who took antidepressants first and added tramadol, the rate was 22 seizures per 100 person-years for those taking CYP2D6-inhibiting antidepressants compared to 20 seizures per 100 person-years in people taking other antidepressants.

To help ensure the differences were not due to other health issues, the researchers adjusted for factors such as pain levels, depression symptoms, physical function and cognitive ability.

After adjustments, for people who took tramadol first, seizure risk was 9% higher when taking it with a CYP2D6-inhibiting antidepressant compared to with an antidepressant that did not inhibit this enzyme. For those who took an antidepressant first and added tramadol, the risk was about 6% higher for people who took a CYP2D6-inhibiting antidepressant compared to people who took an antidepressant that did not inhibit the enzyme.

To test whether this interaction was specific to tramadol, the researchers repeated the analysis using hydrocodone, another opioid pain reliever that is unlikely to cause seizure risk when used with antidepressants. No increased seizure risk was observed with hydrocodone and CYP2D6-inhibiting antidepressants.

“These findings underscore the need for careful prescribing practices, especially for older adults with complex health conditions,” said Wei. “Doctors should be aware of potential seizure risks when prescribing tramadol with antidepressants, particularly CYP2D6 inhibitors. Given how commonly both are prescribed to older adults, these interactions may be more important than previously thought.”

A limitation of the study was that medication data came from prescription records, which did not confirm whether patients took the drugs as directed.

This research was supported by the National Institute on Aging.

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Now, a study shows, 21% of women and 10% of men in Generation X and the tail end of the Baby Boom generation, now in their 50s and early 60s, meet criteria for addiction to these ultra-processed foods.

That rate is far higher than it is among adults who grew up just a decade or two earlier, and only encountered ultra-processed foods in adulthood. Among adults age 65 to 80, just 12% of women and 4% of men meet criteria for ultra-processed food addiction.

The study, published in the journal Addiction by a team from the University of Michigan, is based on nationally representative data from more than 2,000 older Americans surveyed by the U-M National Poll on Healthy Aging.

The poll is based at the U-M Institute for Healthcare Policy and Innovation and supported by Michigan Medicine, U-M’s academic medical center. The new paper builds on a previous poll report by diving deeper into generational differences and correlations with health.

Measuring food addiction in an under-studied group

The researchers used the modified Yale Food Addiction Scale 2.0 (mYFAS 2.0), a standardized tool adapted from the criteria used to diagnose substance use disorders. The scale asks about 13 experiences with ultraprocessed foods and drinks that define addiction, such as strong cravings, repeated unsuccessful attempts to cut down, withdrawal symptoms, and avoiding social activities because of fear of overeating.

In this case, the “substance” is not alcohol or nicotine, but highly rewarding ultra-processed foods such as sweets, fast food, and sugary beverages. By applying clinical addiction criteria to ultra-processed foods, the study highlights the ways in which such foods can “hook” people.

“We hope this study fills a gap in knowledge about addiction to ultra-processed foods among older adults, as measured by a well-studied and standardized scale,” said Lucy K. Loch, a graduate student in the U-M Department of Psychology. “Today’s older adults were in a key developmental period when our nation’s food environment changed. With other research showing clear links between consumption of these foods and risk of chronic disease and premature death, it’s important to study addiction to ultra-processed foods in this age group.”

Differences by gender

Unlike traditional substance use disorders — which historically have been more common in older men — ultra-processed food addiction shows the opposite pattern: higher prevalence in older women.

One explanation may be the aggressive marketing of “diet” ultra-processed food to women in the 1980s.

Low-fat cookies, microwaveable meals, and other carbohydrate-heavy products were promoted as weight-control solutions, but their engineered nutrient profiles may have reinforced addictive eating patterns.

Women now aged 50 to 64 may have been exposed to ultraprocessed foods during a sensitive developmental window, which may help explain the poll’s findings for this age group, said senior author Ashley Gearhardt, Ph.D., a professor of psychology at U-M and member of IHPI. Gearhardt leads the U-M Food and Addiction Science & Treatment Lab.

“The percentages we see in these data far outpace the percentages of older adults with problematic use of other addictive substances, such as alcohol and tobacco,” said Gearhardt. “We also see a clear association with health and social isolation, with much higher risks of ultra-processed food addiction in those who call their mental or physical health status fair or poor, or say they sometimes or often feel isolated from others.”

Key findings related to overweight, health status and social isolation

• Overweight self-perception:
  • Women aged 50 to 80 who said they are overweight were more than 11 times as likely to meet criteria for ultra-processed food addiction than women who say their weight is about right. Men who reported being overweight were 19 times as likely.
  • No matter what their age, 33% of women who described themselves as overweight, 13% of women who described themselves as slightly overweight and 17% of men who described themselves as overweight met criteria for addiction to ultra-processed foods. Of the total sample, 31% of women and 26% of men in the sample said they were overweight and 40% of women and 39% of men said they were slightly overweight.
• Health status:
  • Men reporting fair or poor mental health were four times as likely to meet criteria for ultra-processed food addiction; women were nearly three times as likely.
  • For physical health, men reporting fair or poor health were three times as likely to meet criteria for ultra-processed food addiction, and women were nearly two times as likely.
• Social isolation: Men and women who reported feeling isolated some of the time or often were more than three times as likely to meet criteria for ultra-processed food addiction as those who did not report isolation.

The researchers suggest that individuals who perceive themselves as overweight may be particularly vulnerable to “health-washed” ultra-processed foods – those marketed as low-fat, low-calorie, high-protein or high-fiber, but still formulated to amplify their appeal and maximize craving.

“These products are sold as health foods – which can be especially problematic for those trying to reduce the number of calories they consume,” Gearhardt said. “This especially affects women, because of the societal pressure around weight.”

Looking Ahead

The generation of older adults now in their 50s and early 60s is the first to live most of their lifespan in a food environment dominated by ultra-processed foods, Geahardt noted.

“These findings raise urgent questions about whether there are critical developmental windows when exposure to ultra-processed foods is especially risky for addiction vulnerability,” she said. “Children and adolescents today consume even higher proportions of calories from ultra-processed foods than today’s middle-aged adults did in their youth. If current trends continue, future generations may show even higher rates of ultra-processed food addiction later in life.”

She added, “Just as with other substances, intervening early may be essential to reducing long-term addiction risk across the lifespan.”

About the study

The study was funded by a National Science Foundation Graduate Research Fellowship Program (DGE-2241144) and the National Institute on Drug Abuse of the National Institutes of Health (5R01DA055027).

In addition to Loch and Gearhardt, the study’s co-authors are Matthias Kirch, M.S., Dianne C. Singer, M.P.H, Erica Solway, Ph.D., M.S.W., M.P.H., J. Scott Roberts, Ph.D. and poll director Jeffrey T. Kullgren, M.D., M.P.H., M.S. Roberts is a member of the faculty at the U-M School of Public Health, and Kullgren is a member of the faculty in the U-M Medical School and a primary care physician at the VA Ann Arbor Healthcare System.

Learn more about the National Poll on Healthy Aging, including methodology, at https://www.healthyagingpoll.org/

Citation: Ultra-processed food addiction in a nationally representative sample of older adults in the USA, Addiction, DOI: 10.1111/add.70186, https://doi.org/10.1111/add.70186

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The AGS panel is comprised of 19 national experts from 14 states, including Noll Campbell, PharmD, M.S., of the Regenstrief Institute and Purdue University College of Pharmacy. Dr. Campbell is the only expert from Indiana. The panel is a multidisciplinary AGS panel of physicians, pharmacists, nurses, psychologists and physical therapists that systematically reviewed and curated alternatives for some of the most challenging prescribing scenarios faced in geriatric practice.

The AGS Beers Criteria^® identifies medications that are more likely to harm than help older adults due to side effects such as sedation, falls, delirium and interactions with other conditions. Recommendations are structured for rapid use in clinical practice, emphasizing clear tables referenced by symptom or diagnosis and supplemented by links to reliable resources for both health professionals and the public.

“In practice, we see the risks of potentially inappropriate medications play out in the emergency rooms, clinics, nursing homes or when families are struggling at home,” said Dr. Campbell. “Our aim with this document is to provide support beyond saying ‘don’t prescribe,’ by offering clinicians, patients and families with a list of credible, actionable alternatives — whether it’s a safer medicine or a proven lifestyle approach.”

A novel feature is the inclusion of patient and caregiver-friendly materials, from decision aids and handouts on deprescribing to support for making lifestyle changes — reflecting a modern, team-based and patient-centered approach to medication safety for older adults. All of these resources are generated and hosted by the American Geriatrics Society.

Rigorous, interprofessional approach
Panelists were assigned to eight topic-specific workgroups covering insomnia and anxiety; allergy and pruritus (itchy skin); cardiovascular and anticoagulation therapies; pain; delirium and dementia; diabetes; gastrointestinal syndromes; and genitourinary syndromes.

Each group sought and reviewed high-quality guidelines, best-practice documents and systematic reviews most applicable to common geriatric scenarios. These resources were then distilled into tables of alternatives for 21 common conditions. The panel prioritized U.S.-based guidance but included international sources when more recent or rigorous. Notably, selections focused on both medications and non-pharmacologic alternatives — such as cognitive behavioral therapy for insomnia, exercise and physical therapy for Parkinson’s disease, lifestyle changes for constipation and heartburn, and behavioral or dietary interventions for urinary symptoms.

Core principles for safer prescribing
To guide clinicians, the panel offers five key principles.

• Stopping a potentially inappropriate drug is not the ultimate goal; the priority is to help patients feel better and reduce the risk of harm.
• Non-drug (behavioral and lifestyle) strategies should often be first line.
• Always seek the underlying cause of symptoms before prescribing.
• Avoiding a risky drug is important, but clinical judgment and individualization remain critical.
• Use the many available resources for patients, caregivers and clinicians to support implementation and deprescribing.

Balancing real-world practice, research gaps and patient and caregiver needs
The panel acknowledges that guidelines and systematic reviews often lack specificity for the oldest or most complex patients, and that real-life symptoms (e.g., insomnia, involuntary weight loss) are not always tied to a single clear diagnosis. As described in the article’s discussion, recommendations remain flexible, encouraging clinicians to tailor approaches according to each individual’s clinical status, functional goals and life circumstances.

“We recognize that simply removing a medication may not be enough, especially if symptoms return or worsen,” said Dr. Campbell. “Our intent is to provide practical, prioritized alternatives that can be started or considered right away, so that care is both safer and responsive to what matters most to older adults and their caregivers. We want clinicians to have real tools, not just warnings.”

Authors are from the following states: Alabama, Arkansas, California, Colorado, Connecticut, Illinois, Indiana, Iowa, Maine, Michigan, Missouri, New York, Texas and Utah.

“Alternative Treatments to Selected Medications in the 2023 American Geriatrics Society Beers Criteria^®” is published in the Journal of the American Geriatrics Society, a peer-reviewed publication.

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“With the AGS Beers Criteria®, we help clinicians recognize medications that are  potentially inappropriate for use in older adults,” said Michael Steinman, MD, AGSF, AGS Beers Criteria® Co-Chair and Co-Chair of the panel that developed the AGS Alternatives List. “Now, with the updated Alternatives List, we’re taking the next step—offering evidence-based suggestions for what non-pharmacologic and pharmacologic treatments clinicians might use instead.”

“We really took a step back and asked, ‘Where are clinicians likely to run into challenges with the Beers Criteria®—and where would having clear alternatives be most helpful?’” added Todd P. Semla, MS, PharmD, Co-Chair of the Alternative List Panel and AGS Beers Criteria®. “The expert panel focused on the medications that we thought would be most helpful to provide alternatives for—making sure we hadn’t missed anything important and that our selections truly reflected the needs of those caring for older adults.”

To develop the new AGS Beers Criteria® Alternatives List, AGS convened an interdisciplinary work group of experts across a variety of clinical syndromes and disease areas. The result is a curated list of common evidence-based alternatives that are often safer and equally or more effective than the potentially inappropriate medications they can replace. The list also includes additional resources for more in-depth recommendations and links to patient guides and other resources for help in implementing the alternative strategies into their clinical practice.

“This resource is designed with the needs of clinicians in mind – from its clear organization to its practical accessibility,” said AGS President, Paul Mulhausen, MD, MHS, AGSF. “I know this is going to be a go-to resource for many of us working to provide safer, more personalized care for older adults.”

This new resource reflects AGS’s ongoing commitment to supporting safer prescribing and improving health outcomes for older adults. The Alternative Treatments to Selected Medications in the 2023 American Geriatrics Society Beers Criteria® (DOI: 10.1111/jgs.19500) has just been published in the most recent edition of the Journal of the American Geriatrics Society (JAGS) and will soon be incorporated into the AGS Beers Criteria® Mobile App for easy access on-the-go.

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