(DURHAM, NC) Whether it’s a blood pressure pill, something for cholesterol, or a medication to help you sleep, it’s easy to accumulate prescriptions over time, especially during midlife.
But a Duke University School of Medicine study suggests that taking multiple medications may be associated with how strong, mobile, and steady you feel even before old age sets in.
Researchers using the long-running CARDIA study looked at data from nearly 2,000 adults, average age 60, and found that nearly 1 in 3 were taking five or more medications — a threshold considered polypharmacy. Those taking five or more prescriptions walked slower, had weaker grip strength, and showed worse balance than peers on fewer medications.
“What this tells us is that physical decline related to medication use may not be just a problem for people in their 70s or 80s,” said lead study author Caroline Sloan, MD, MPH, an internist at Duke Health and expert in population health sciences. “It could start showing up in your 50s or early 60s, when people still expect to be independent and mobile.”
There’s strong evidence that taking five or more medications can worsen physical function and increase the risk of falls in older adults, partly due to drug interactions or overlapping health conditions.
But few studies have looked at these effects in middle-aged adults.
Sloan worked with Duke Health geriatrician and chronic disease expert Christopher Barrett Bowling, MD, on the study published July 7 in the Journal of General Internal Medicine.
Researchers measured physical function using five standardized tests — including grip strength, gait speed, and a six-minute walk — and combined the results into a single score called the CARDIA Physical Performance (CAPP) score.
Those taking five or more medications scored, on average, 1.24 points lower on the 20-point CAPP scale than those not taking multiple medications — a gap that reflects a real and meaningful difference.
Results from an additional part of the study suggest that it’s not necessarily the type of drug that matters, but the sheer number.
“If I’m seeing a 58-year-old on 15 medications, that should prompt me to think about their physical function. They may benefit from a physical therapy referral or an exercise program and more broadly, it’s an opportunity to take a closer look at their medication list.”
- Caroline Sloan, MD, internal medicine physician
The researchers examined the use of potentially inappropriate medications (PIMs), a category defined by the Beers Criteria as medications that should be avoided in older adults that includes heart and anxiety medicines along with other drugs. While 25% of participants were taking at least one PIM, use of these medications alone did not independently predict lower physical performance once polypharmacy was accounted for.
“We expected that the specific drugs considered inappropriate for older adults would have the biggest impact,” Sloan said. “But instead, it was really the number of medications that stood out.”
To be clear, the study doesn’t prove that taking multiple medications causes poor physical function. Polypharmacy is common in adults, and people may be taking more medications because of underlying health problems that also affect their strength and mobility.
Still, the association offers a potential red flag for clinicians, especially primary care doctors who may not routinely assess physical performance in patients under age 65.
“If I’m seeing a 58-year-old on 15 medications, that should prompt me to think about their physical function,” Sloan said. “They may benefit from a physical therapy referral or an exercise program and more broadly, it’s an opportunity to take a closer look at their medication list.”
The study found no significant differences in the impact of polypharmacy by sex or race.
However, women and Black participants were more likely to be on higher numbers of medications, highlighting potential disparities in how chronic conditions are managed in midlife.
The research adds to growing calls for more individualized prescribing and more attention to functional health — not just blood pressure and lab values — as people enter older age.
Additional Authors: Marissa C. Ashner, PhD; Cara L. McDermott, PharmD, PhD; and Carl Pieper, PhD, all of Duke and Brett T. Burrows, PhD; Ankeet S. Bhatt, MD, MBA; and Kelley Pettee Gabriel, PhD.
Funding: National Institute on Aging and Duke Pepper Older Americans Independence Center.