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Why medicines need regular review in aged care

Residents & families Aged care staff 6 min read

By Dr Josh Hatch, FRACGP

Most people move into residential aged care with a long list of medicines, each started for a reason at some point in the past. A 2020 report from the Pharmaceutical Society of Australia, drawing on Australian studies, found that more than 95% of residents had at least one problem with their medicines when a review was done 2. Most of these problems come to light only when someone looks.

Numbers in the text link to the 8 sources listed at the foot of this page.

The Australian picture

9 to 11

different medicines is the average for a resident, according to the Pharmaceutical Society of Australia’s 2020 review of Australian studies 2.

More than half

of residents are prescribed at least one medicine generally considered potentially inappropriate for older people. Across seven Australian studies the figure ranged from 30% to 73% 2.

About 1 in 5

unplanned hospital admissions of aged care residents result from a potentially inappropriate medicine, based largely on a Western Australian study that found 18% 2.

35%

of 5,709 residents in 25 New South Wales homes had at least one medication incident recorded between 2014 and 2021. Residents given more than five medicines had about twice the rate of incidents 4.

How medication lists grow

Studies of residential care in many countries report that up to 91% of residents take more than five medicines and up to 74% take more than nine, depending on how the count is made. A recent discharge from hospital and having more than one prescriber are both linked with longer lists 1.

Each medicine usually had a good reason when it was started. Reasons change. A blood pressure tablet started at 70 may be too strong at 90, when a person weighs less and stands up more slowly. A medicine that prevents a problem years from now may no longer fit a person whose priorities are comfort and time with family.

Some medicines are also taken for much longer than intended. In Department of Veterans’ Affairs data for 14,237 Australian residents, 52% were dispensed a proton pump inhibitor, with a median of 360 days of supply in the year, and one in five were dispensed an antipsychotic, with a median of 180 days 3. Both are medicines that national and international guidance asks prescribers to review regularly 2135.

What a review looks at

The strengthened Quality Standards require providers to have processes for medication review at least once a year, and after a move between care settings, an acute illness or an adverse event 8. A good review asks a few plain questions about each medicine.

  • Is it still needed?. The condition it was started for may have settled, or the goal of treatment may have changed. Where a person takes many medicines, the Standards guidance asks reviewers to consider whether each one is still needed 8.

  • Is it doing what it was meant to do?. Some medicines have an effect that can be checked. Others aim to prevent something in the future, and the question is whether that future benefit still matters to the person.

  • Could it be causing a problem?. Drowsiness, confusion, constipation or dizziness can look like ageing. A review asks whether a new problem could be coming from a medicine.

  • What would happen if it stopped?. Some medicines can be stopped at once, some need to be reduced slowly, and a few should not be stopped at all. The Standards guidance names the risks of stopping as part of the review 8.

  • What does the resident want?. Taking fewer tablets, avoiding a side effect, or keeping a medicine that helps them feel well are all reasonable priorities.

Fewer medicines is not the goal in itself

Medication review is sometimes described as cutting down. The aim is the right medicines for this person now. Sometimes that means stopping something. Sometimes it means starting something that is missing. In a New South Wales study, about two in five residents taking long-term medicines that raise the risk of stomach bleeding had no proton pump inhibitor to protect the stomach 33.

Related pages on this site

Sources cited on this page

  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
  2. 2 Pharmaceutical Society of Australia. Medicine Safety: Aged Care. Canberra: PSA; February 2020. (Narrative report drawing on Australian studies.) View source
  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
  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
  5. 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
  6. 21 Australian Commission on Safety and Quality in Health Care. Psychotropic Medicines in Cognitive Disability or Impairment Clinical Care Standard. Sydney: ACSQHC. View source
  7. 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
  8. 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

See every source cited across the medicines and deprescribing section →

Written by Dr Josh Hatch, FRACGP. General information only, reflecting his reading of the published evidence as at October 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment. Evidence and Australian regulatory, PBS and program arrangements change — always confirm current advice with the treating GP, pharmacist or specialist.

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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