TOPLINE

Polypharmacy was observed in around 60% of adults aged 75 years or older with metabolic dysfunction-associated steatotic liver disease (MASLD), exceeding rates in younger adults with MASLD. Those older than 75 years also had higher odds of polypharmacy than those aged 65 to 69 years.

METHODOLOGY

• Researchers analyzed data from the National Health and Nutrition Examination Survey (2017-2020), including 1756 adults aged 65 years or older with available transient elastography and laboratory results, to characterize patterns of polypharmacy and identify risk factors among those with MASLD.
• Overall, 39.8% met the criteria for MASLD; among adults with MASLD, roughly one third were aged 65-69 years, 70-74 years, and 75 years or older.
• Researchers recorded the number and classes of prescription medications taken by participants. Polypharmacy was defined as the use of five or more medications and hyperpolypharmacy as the use of 10 or more medications.
• A modified drug burden index was calculated by adding prescribed sedative and anticholinergic medications; a modified score of greater than 0 indicated the presence of drug burden, and a modified score ≥ 2 indicated a high drug burden.

TAKEAWAY

• Rates of polypharmacy increased with age among adults with MASLD, rising from 36.9% in those aged 65-69 years to 42.2% in those aged 70-74 years and 60.3% in those older than 75 years.
• Adults aged 75 years or older with MASLD had significantly higher rates of polypharmacy than adults of the same age without MASLD (60.3% vs 42.7%; P = .005) and used more total medications (mean, 5.4 vs 4.5; P = .004).
• Compared with adults with MASLD in the younger age group, those older than 75 years had higher odds of polypharmacy after adjustment for cardiometabolic risk factors (adjusted odds ratio [aOR], 2.72; P < .001) and cardiometabolic conditions (aOR, 2.89; P < .001).
• Among older adults with MASLD, the rates of antihypertensive medication use were 58.5% in the youngest age group, 47.6% in the middle age group, and 67.6% in the oldest age group (P = .01); adults aged 65-69 years without MASLD had greater benzodiazepine use than those with MASLD (17.9% vs 6.8%; P = .006).

IN PRACTICE

“[The study] findings underscore the need for individualized, age-conscious care for older adults with MASLD. Polypharmacy should prompt structured medication review that considers life expectancy, quality of life, and patient goals,” the authors wrote.

SOURCE

The study was led by Melinda Wang, MD, MHS, of the Division of Gastroenterology and Hepatology in the Department of Medicine at the University of California, San Francisco. It was published online on July 14, 2026, in the Journal of General Internal Medicine.

LIMITATIONS

Participants reported their own medication use, which was verified by checking containers and limited to prescription drugs, possibly underestimating the total pill burden. The dataset lacked information about prescribing and primary care provider characteristics that could affect polypharmacy based on location.

DISCLOSURES

The researchers did not report any specific funding. One author disclosed receiving research support to her institution from Lipocene and Gore Medical, serving on an advisory board for Boehringer Ingelheim and Cosmo, and providing consulting services for Novo Nordisk.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.