“Less than 10% of those who participated in the trials of these drugs were over the age of 65,” says Chen. “There’s much more potential for issues because people in this age range may have other chronic conditions and be on [other] medications.”
So what are some of the main dangers the over-60s need to be aware of before taking the jabs or the new pill?
Severe constipation and bowel tears
Almost a third of over-60s already suffer from constipation. This often occurs because people aren’t hydrated enough or aren’t eating enough fibre, while age-related changes to the digestive tract can also slow the movement of waste products.
“I have a lot of patients who are surprised by this when they reach their 60s or 70s,” says Chen. “They say, ‘Man, I’ve never had constipation, now I’m really struggling with it.’”
According to Chen, in this situation, GLP-1s can act as something of a double whammy because they’re actively slowing the movement of food through the small intestine. When she carried out a small survey of six people over the age of 65 who are currently taking GLP-1s, she was struck by the fact that five of them reported really bad constipation.
“Some of the patients I talk to will say, ‘I didn’t have a bowel movement for five days, and before that I was going every day,’” she says.
This can not only be highly unpleasant, it often results in severe abdominal pain, which Chen says requires urgent medical attention and treatment with stool-softening medication. It’s unclear what exactly happened to Savage, but in serious cases, if left untreated, hard, trapped stool can cut off blood supply and cause perforation of the bowel, resulting in intestinal necrosis (tissue death) and a hole forming.
“It’s more common than you would think,” says Chen. “When I rotate on the inpatient service for older adults that we have at Yale, it’s pretty common for me to treat patients with this.”
Dehydration and kidney injury
Serious constipation can also arise if people taking GLP-1s aren’t drinking enough, a concern voiced by geriatricians who have noticed that older patients who are taking the drugs commonly end up living in a state of mild-to-moderate dehydration.
“Because of the drugs, your body might not be giving you the thirst signals that you need,” says Chen. “I’m telling my patients to carry a water bottle around even when they’re not thirsty.”
Being dehydrated can increase the risk of falls. And Melanie Jay, an obesity specialist at NYU Langone, says that in rare cases, not taking in sufficient fluid can lead to kidney injury or failure.
This risk may be heightened in people over 60 who are already taking other medications, such as diuretics to treat high blood pressure, which makes you urinate more often, or people with type 2 diabetes.
“People with diabetes tend to already have a little bit of subclinical [early stage] kidney damage,” says Jay. “Then if you’re suddenly dehydrated, you don’t have as much blood flow to the kidneys. So you’re taking someone who is already vulnerable, then putting more pressure on their kidneys.”
Unpleasant interactions with other medication
A quarter of over-60s in the UK are living with two or more long-term health conditions, and a tenth of over-65s are taking at least eight different prescription medications.
In this context, Chen says adding a GLP-1 drug is akin to opening up Pandora’s box. “So many different things can happen,” she says.
She had read case reports of a number of older adults who were taking weight-loss drugs alongside thyroid-hormone-replacement therapy, which is carefully dosed according to a person’s weight. “Then they take a GLP-1, lose a lot of weight, and no one thinks to adjust the dose of the levothyroxine,” says Chen.
In these cases, it led to hyperthyroidism, a condition where too much thyroid hormone ends up circulating in the bloodstream, leading to heart palpitations, muscle weakness and anxiety.
Vitamin deficiencies, muscle weakness and frailty
While obesity increases the risk of various chronic health conditions, losing weight too quickly can result in the loss of muscle, not just fat, which affects a person’s balance and can even make them more at risk of fractures.
Many geriatricians say that it’s vital that over-60s taking GLP-1s combine the drug treatment with strength-training exercises such as push-ups or lifting weights to avoid weakening muscles and thinning bones.
GLP-1s curb appetite, so people consume smaller amounts of food. According to Chen, it’s therefore paramount that older adults ensure that the food they are eating is good quality. Over-60s are already more vulnerable to various vitamin and mineral deficiencies because the ageing gut no longer makes and absorbs nutrients such as vitamin B12 quite so efficiently, while requirements for key minerals like calcium, zinc and magnesium increase with age.
“Iron and B vitamins tend to be the first ones that people are at risk of becoming deficient in,” says Chen.
The consequences of this can be worsening physical and cognitive frailty – the latter often occurring when people are deficient in vitamin B12. To avoid this, Chen promotes more lean proteins such as fish, chicken, tofu and beans, and less red meat, while urging over-60s using GLP-1s to cut out all fizzy drinks and limit heavily processed foods.
She’s also concerned by reports of influencers – and even some medical professionals – promoting the idea of fasting diets alongside GLP-1 drugs, which could leave them more likely to become deficient in key nutrients and potentially accelerate underlying health issues.
“Fasting alongside GLP-1s sounds like a really bad idea,” says Chen. “That scares me. The consequences are that it could induce some of this muscle loss.”
How to take weight-loss medication safely after 60
While there are certainly risks, GLP-1s can still offer many benefits to the over-60s. Statistics show that more than a third of 55 to 74-year-olds in the UK are obese, which puts them at higher risk of serious health issues such as cancer and heart disease.
Chen says that when she speaks to people looking to start these drugs, they’ve often been prompted by news that a friend or their spouse has developed a health problem or simply a desire to improve their quality of life.
“Many over-60s want to improve their appearance, just like younger generations,” she says. “For some, losing weight could also mean being on fewer medications or less joint pain, allowing them to get out more with friends and be more social. I’ll speak to people who tell me they began noticing they were short of breath when walking around and realised they wanted to make a change.”
But with access to GLP-1 medications highly restricted on the NHS, millions of people are getting the drugs via various online pharmacies and providers with little or no medical oversight.
Chen’s advice is that while these drugs can lead to health benefits, it’s important to take the risks seriously, and if you’re over 60, it’s all the more important to make sure that you’re doing so with the advice of a doctor.
“It can be more complex, especially if you’re taking other medications,” she explains. While a younger person can cope more when it comes to ramping up the doses every month, Chen’s recommendation is that over-60s should take a much more gradual and steady approach.
“It’s not a sprint; it’s a marathon. You can run into problems ramping up too fast, but you’re not going to run into problems ramping too slow,” she says. “There’s really no reason to go quickly.”
