Abstract
BACKGROUND AND OBJECTIVE: Polypharmacy is common in older adults due to multimorbidity and is associated with frailty, falls, decreased function, and mortality. However, the association between older age and polypharmacy has never been studied in the context of limited English proficiency (LEP). We investigated whether older adults with LEP were more likely to experience polypharmacy than older adults who are English proficient. DESIGN, PARTICIPANTS, AND MAIN MEASURES: We conducted a cross-sectional analysis of pooled 2013-2018 Medical Expenditure Panel Survey (MEPS), a nationally representative US household survey. Participants were community-dwelling adults aged 65 and older. Polypharmacy was defined as using five or more prescription medications. LEP was defined as participants who reported speaking English "not well" or "not at all" and spoke a non-English language at home. We used multivariable logistic regression models adjusted for demographic, socioeconomic, and health characteristics. KEY RESULTS: There were 27,697 MEPS respondents representing 50.5 million community-dwelling older adults. In total, 57.7% of participants were 65-74 years old; 55.2% female; 76.4% white; and 9.8% living below the federal poverty line. The median number of chronic conditions was 3 (IQR, 2-5). A total of 57.8% (95% CI, 56.7-58.9%) used five or more medications, and 4.6% (95% CI, 4.1-5.2%) had LEP. In unadjusted analyses, polypharmacy was less common among older adults with LEP than English-proficient adults (51.7% vs. 58.1%; p < 0.001), which remained significant after adjusting for demographic, socioeconomic, and health characteristics (aOR = 0.79, 95% CI 0.67-0.97; p = 0.03). CONCLUSIONS: In a representative sample of community-dwelling older adults, older adults with LEP were less likely to experience polypharmacy compared to older adults who are English proficient. While polypharmacy is associated with safety concerns, lower prevalence among individuals with LEP may reflect barriers to care rather than better prescribing practices, underscoring the need for language-concordant interventions to improve medication adherence and accessibility while avoiding inappropriate medications.