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Umbrella Aged Care
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Evidence and sources

Every empirical claim in this section is tied to a named source. This is the full list of 45 trials, systematic reviews, guidelines and Australian regulatory documents, with the topic pages that rely on each one.

How these sources are used

Interventions are graded on randomised trial evidence for the outcome that matters: symptoms, function, quality of life, hospital admission or survival. Trials in residential care are preferred. Where the only evidence comes from hospitals, from people living at home or from studies that were not randomised, that is stated where the finding is described.

Observational studies, cross-sectional surveys and single-arm programs are labelled as such. Much of what is known about how medicines are used in Australian aged care comes from observational data, and it is presented that way.

Australian regulatory details, quality indicator definitions, PBS arrangements and pharmacy program rules are correct as at the review date below and change. Confirm current arrangements against the primary source before relying on them.

Last full evidence review: October 2026.

Sources

  1. 1

    Jokanovic N, Tan ECK, Dooley MJ, Kirkpatrick CM, Bell JS. Prevalence and factors associated with polypharmacy in long-term care facilities: a systematic review. J Am Med Dir Assoc. 2015;16(6):535.e1–12. (44 studies.) View source

    Cited in: Why medicines need regular review in aged care

  2. 2

    Pharmaceutical Society of Australia. Medicine Safety: Aged Care. Canberra: PSA; February 2020. (Narrative report drawing on Australian studies.) View source

    Cited in: Why medicines need regular review in aged care

  3. 3

    Kalisch Ellett LM, Kassie GM, Pratt NL, Kerr M, Roughead EE. Prevalence and duration of use of medicines recommended for short-term use in aged care facility residents. Pharmacy (Basel). 2019;7(2):55. (Department of Veterans’ Affairs claims data, 14,237 residents, 2015–2016; observational.) View source

    Cited in: Why medicines need regular review in aged care Antipsychotics, benzodiazepines and chemical restraint Sleeping tablets

  4. 4

    Silva SSM, Wabe N, Raban MZ, et al. Characteristics and risk factors of medication incidents across stages of medication management in residential aged care: a longitudinal cohort study of 5700 reported incidents. Drug Saf. 2026;49(2):195–206. (25 New South Wales homes, 2014–2021; observational.) View source

    Cited in: Why medicines need regular review in aged care Medicines: a guide for facility leadership

  5. 5

    Australian Institute of Health and Welfare, GEN Aged Care Data. Residential Aged Care Quality Indicators — April to June 2026. Released October 2026. (2,564 residential care homes; trend analysis July–September 2021 to April–June 2026.) View source

    Cited in: Medicines: a guide for facility leadership

  6. 6

    Australian Government Department of Health, Disability and Ageing. National Aged Care Mandatory Quality Indicator Program: quick reference guide — medication management, polypharmacy. 2025. View source

    Cited in: Medicines: a guide for facility leadership

  7. 7

    Australian Government Department of Health, Disability and Ageing. National Aged Care Mandatory Quality Indicator Program: quick reference guide — medication management, antipsychotics. 2025. View source

    Cited in: Medicines: a guide for facility leadership

  8. 8

    Aged Care Quality and Safety Commission. Strengthened Aged Care Quality Standards: Outcome 5.3 Safe and quality use of medicines, Actions 5.3.1 to 5.3.6, with guidance. View source

    Cited in: Why medicines need regular review in aged care Medicines: a guide for facility leadership

  9. 9

    Alldred DP, Kennedy MC, Hughes C, Chen TF, Miller P. Interventions to optimise prescribing for older people in care homes. Cochrane Database Syst Rev. 2016;(2):CD009095. (12 randomised trials, 10,953 residents.) View source

    Cited in: Deprescribing: what the trials show Medicines: a guide for facility leadership

  10. 10

    Carollo M, Cristini I, Crisafulli S, et al. Evaluating the impact of medication review and deprescribing on prescribing appropriateness and clinical outcomes in older people residing in long-term care facilities: a systematic review and meta-analysis. Age Ageing. 2026;55(4):afag084. (38 studies, 22 randomised; search to August 2024.) View source

    Cited in: Deprescribing: what the trials show Medicines: a guide for facility leadership

  11. 11

    Page AT, Clifford RM, Potter K, Schwartz D, Etherton-Beer CD. The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis. Br J Clin Pharmacol. 2016;82(3):583–623. (All settings; randomised and non-randomised studies.) View source

    Cited in: Deprescribing: what the trials show

  12. 12

    Potter K, Flicker L, Page A, Etherton-Beer C. Deprescribing in frail older people: a randomised controlled trial. PLoS One. 2016;11(3):e0149984. (95 residents, four rural Western Australian homes; open-label.) View source

    Cited in: Deprescribing: what the trials show

  13. 13

    Dyer SM, Kwok WS, Suen J, et al. Interventions for preventing falls in older people in care facilities. Cochrane Database Syst Rev. 2025;8:CD016064. (104 randomised trials.) View source

    Cited in: Deprescribing: what the trials show

  14. 14

    Suen J, Narayan S, Seppala LJ, et al. Features of successful medication review and deprescribing interventions for fall prevention in residential aged care facilities: an intervention component analysis of an updated systematic review. Age Ageing. 2025;54(8):afaf230. (13 trials; hypothesis-generating.) View source

    Cited in: Deprescribing: what the trials show Medication reviews and pharmacists in aged care Medicines: a guide for facility leadership

  15. 15

    Kutner JS, Blatchford PJ, Taylor DH, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med. 2015;175(5):691–700. (Palliative care settings; unblinded.) View source

    Cited in: Preventive medicines when life expectancy is limited

  16. 16

    Van Leeuwen E, Petrovic M, van Driel ML, et al. Withdrawal versus continuation of long-term antipsychotic drug use for behavioural and psychological symptoms in older people with dementia. Cochrane Database Syst Rev. 2018;3:CD007726. (10 randomised trials, 632 participants.) View source

    Cited in: Deprescribing: what the trials show Antipsychotics, benzodiazepines and chemical restraint

  17. 17

    Brodaty H, Aerts L, Harrison F, et al. Antipsychotic deprescription for older adults in long-term care: the HALT study. J Am Med Dir Assoc. 2018;19(7):592–600.e7. (Single-arm study, 23 Sydney nursing homes; not randomised.) View source

    Cited in: Antipsychotics, benzodiazepines and chemical restraint Medicines: a guide for facility leadership

  18. 18

    Westbury JL, Gee P, Ling T, et al. RedUSe: reducing antipsychotic and benzodiazepine prescribing in residential aged care facilities. Med J Aust. 2018;208(9):398–403. (Prospective non-randomised intervention, 150 homes.) View source

    Cited in: Antipsychotics, benzodiazepines and chemical restraint Medicines: a guide for facility leadership

  19. 19

    Sawan MJ, Clough AJ, Hillen J, et al. Variation in the potentially inappropriate use of antipsychotic and benzodiazepine medications among individuals receiving residential medication management reviews. Int J Pharm Pract. 2025;33(3):332–9. (15,442 residents in 342 Australian homes, 2019; cross-sectional.) View source

    Cited in: Antipsychotics, benzodiazepines and chemical restraint Medicines: a guide for facility leadership

  20. 20

    End of Life Law for Clinicians, Australian Centre for Health Law Research, Queensland University of Technology. Restrictive Practices in Aged Care (factsheet on the Aged Care Act 2024 and Aged Care Rules 2025). November 2025. View source

    Cited in: Antipsychotics, benzodiazepines and chemical restraint Medicines: a guide for facility leadership

  21. 21

    Australian Commission on Safety and Quality in Health Care. Psychotropic Medicines in Cognitive Disability or Impairment Clinical Care Standard. Sydney: ACSQHC. View source

    Cited in: Why medicines need regular review in aged care Antipsychotics, benzodiazepines and chemical restraint Medicines: a guide for facility leadership

  22. 22

    Coupland CAC, Hill T, Dening T, Morriss R, Moore M, Hippisley-Cox J. Anticholinergic drug exposure and the risk of dementia: a nested case-control study. JAMA Intern Med. 2019;179(8):1084–93. (English primary care data; observational.) View source

    Cited in: Anticholinergic burden

  23. 23

    Kersten H, Molden E, Tolo IK, Skovlund E, Engedal K, Wyller TB. Cognitive effects of reducing anticholinergic drug burden in a frail elderly population: a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2013;68(3):271–8. (87 residents, 22 Norwegian nursing homes.) View source

    Cited in: Anticholinergic burden

  24. 24

    Taylor-Rowan M, Alharthi AA, Noel-Storr AH, et al. Anticholinergic deprescribing interventions for reducing risk of cognitive decline or dementia in older adults with and without prior cognitive impairment. Cochrane Database Syst Rev. 2023;12:CD015405. (3 randomised trials, 299 participants.) View source

    Cited in: Anticholinergic burden

  25. 25

    Liu BM, Redston MR, Fujita K, Thillainadesan J, Gnjidic D, Hilmer SN. The impact of deprescribing interventions on the Drug Burden Index and other outcomes: a systematic review. J Am Med Dir Assoc. 2024;25(7):105021. (9 randomised trials.) View source

    Cited in: Anticholinergic burden

  26. 26

    Yourman LC, Cenzer IS, Boscardin WJ, et al. Evaluation of time to benefit of statins for the primary prevention of cardiovascular events in adults aged 50 to 75 years: a meta-analysis. JAMA Intern Med. 2021;181(2):179–85. (8 trials, 65,383 adults; not in residential care.) View source

    Cited in: Preventive medicines when life expectancy is limited

  27. 27

    McNeil JJ, Woods RL, Nelson MR, et al. Effect of aspirin on disability-free survival in the healthy elderly (ASPREE). N Engl J Med. 2018;379:1499–508. (19,114 community-dwelling adults in Australia and the United States.) View source

    Cited in: Preventive medicines when life expectancy is limited

  28. 28

    Benetos A, Gautier S, Freminet A, et al. Reduction of antihypertensive treatment in nursing home residents (RETREAT-FRAIL). N Engl J Med. 2025;393:1990–2000. View source

    Cited in: Preventive medicines when life expectancy is limited

  29. 29

    Lipska KJ, Ross JS, Miao Y, Shah ND, Lee SJ, Steinman MA. Potential overtreatment of diabetes mellitus in older adults with tight glycemic control. JAMA Intern Med. 2015;175(3):356–62. (US national survey of community-dwelling adults, 2001–2010; cross-sectional.) View source

    Cited in: Diabetes in frail residents

  30. 30

    Stasinopoulos J, Wood SJ, Bell JS, Manski-Nankervis JA, Hogan M, Sluggett JK. Potential overtreatment and undertreatment of type 2 diabetes mellitus in long-term care facilities: a systematic review. J Am Med Dir Assoc. 2021;22(9):1889–97.e5. (15 observational studies.) View source

    Cited in: Diabetes in frail residents

  31. 31

    Lederle LI, Steinman MA, Jing B, Nguyen B, Lee SJ. Glycemic treatment deintensification practices in nursing home residents with type 2 diabetes. J Am Geriatr Soc. 2022;70(7):2019–28. (7,422 US Veterans Affairs nursing home residents; observational.) View source

    Cited in: Diabetes in frail residents

  32. 32

    Royal Australian College of General Practitioners. Management of type 2 diabetes: a handbook for general practice — Type 2 diabetes management for older people and residential aged care facilities. Recommendations dated 14 November 2024. View source

    Cited in: Diabetes in frail residents

  33. 33

    Wabe N, Urwin R, Meulenbroeks I, et al. Over- and underuse of proton pump inhibitors in nursing homes: a multisite longitudinal cohort study. J Am Med Dir Assoc. 2025;26(2):105393. (6,439 residents, 34 New South Wales homes; observational.) View source

    Cited in: Why medicines need regular review in aged care Stomach and bowel medicines

  34. 34

    Boghossian TA, Rashid FJ, Thompson W, et al. Deprescribing versus continuation of chronic proton pump inhibitor use in adults. Cochrane Database Syst Rev. 2017;3:CD011969. (6 trials, 1,758 outpatients.) View source

    Cited in: Stomach and bowel medicines

  35. 35

    Farrell B, Pottie K, Thompson W, et al. Deprescribing proton pump inhibitors: evidence-based clinical practice guideline. Can Fam Physician. 2017;63(5):354–64. (No DOI; PubMed record linked.) View source

    Cited in: Why medicines need regular review in aged care Stomach and bowel medicines

  36. 36

    Moayyedi P, Eikelboom JW, Bosch J, et al. Safety of proton pump inhibitors based on a large, multi-year, randomized trial of patients receiving rivaroxaban or aspirin. Gastroenterology. 2019;157(3):682–91.e2. (17,598 people with stable cardiovascular disease; two authors affiliated with Bayer.) View source

    Cited in: Stomach and bowel medicines

  37. 37

    Chan TC, Yu VMW, Luk JKH, Chu LW, Yuen JKY, Chan FHW. Effectiveness of partially hydrolyzed guar gum in reducing constipation in long term care facility residents: a randomized single-blinded placebo-controlled trial. J Nutr Health Aging. 2022;26(3):247–51. (52 residents, Hong Kong.) View source

    Cited in: Stomach and bowel medicines

  38. 38

    Musa MK, Saga S, Blekken LE, Harris R, Goodman C, Norton C. The prevalence, incidence, and correlates of fecal incontinence among older people residing in care homes: a systematic review. J Am Med Dir Assoc. 2019;20(8):956–62.e8. (23 observational studies.) View source

    Cited in: Stomach and bowel medicines

  39. 39

    Glass J, Lanctôt KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ. 2005;331:1169. (24 randomised trials, 2,417 participants aged 60 and over.) View source

    Cited in: Sleeping tablets

  40. 40

    Richardson K, Savva GM, Boyd PJ, et al. Non-benzodiazepine hypnotic use for sleep disturbance in people aged over 55 years living with dementia: a series of cohort studies. Health Technol Assess. 2021;25(1):1–202. (Observational.) View source

    Cited in: Sleeping tablets

  41. 41

    Tannenbaum C, Martin P, Tamblyn R, Benedetti A, Ahmed S. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Intern Med. 2014;174(6):890–8. (303 community-dwelling adults, Canada.) View source

    Cited in: Sleeping tablets

  42. 42

    Pharmacy Programs Administrator. Residential Medication Management Review (RMMR) Program Rules. August 2026. View source

    Cited in: Medication reviews and pharmacists in aged care

  43. 43

    Australian Government Department of Health, Disability and Ageing. About aged care on-site pharmacists (Aged Care On-site Pharmacist measure). Accessed October 2026. View source

    Cited in: Medication reviews and pharmacists in aged care

  44. 44

    Haider I, Kosari S, Naunton M, et al. Impact of on-site pharmacists in residential aged care facilities on the quality of medicines use: a cluster randomised controlled trial (PiRACF study). Sci Rep. 2023;13:15962. (15 Australian homes; not blinded.) View source

    Cited in: Medication reviews and pharmacists in aged care Medicines: a guide for facility leadership

  45. 45

    Haider I, Kosari S, Naunton M, et al. The role of on-site pharmacist in residential aged care facilities: findings from the PiRACF study. J Pharm Policy Pract. 2023;16:82. (Descriptive study within the trial.) View source

    Cited in: Medication reviews and pharmacists in aged care

Listing a source is not an endorsement of every conclusion its authors draw, and summarising a trial in one sentence necessarily loses detail. Where a finding matters to a decision, read the original.

Written by Dr Josh Hatch, FRACGP. This page is general information reflecting his reading of these sources, not individual medical advice.

This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.

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