Frailty, polypharmacy, falls risk, and Medicare-specific considerations.
About this article
Sarcopenia is the central concern
Adults over 75 typically have substantially reduced lean mass at baseline. Rapid weight loss accelerates sarcopenia. Resistance training is even more critical than for younger patients.
Falls and dehydration
Reduced thirst sensation + GI symptoms + reduced appetite + sarcopenia = falls risk. Conservative titration, intensive hydration coaching, fall-risk assessment baseline.
Polypharmacy interactions
Common offenders: insulin/sulfonylureas (hypoglycemia), warfarin (INR shifts during weight change), levothyroxine (absorption), digoxin/lithium (narrow therapeutic index + delayed emptying).
Medicare coverage
April 2026 Part D expansion under SELECT-aligned CV pathway: covers Wegovy for BMI ≥27 + established CVD. T2D coverage continues for Ozempic/Mounjaro. Pure obesity indication still excluded by statute.