Medication Review in Aged Care: Key Points

  • Home Medicines Review (HMR) is a Medicare-funded service in which an accredited pharmacist reviews all medications in the home and reports to the GP. Families can ask their GP to arrange one.
  • Residential Medication Management Reviews (RMMRs) are the equivalent service in residential aged care facilities.
  • The signs that a review is needed include falls, confusion, new physical symptoms, recent hospitalisation, and any significant medication change.
  • Polypharmacy is common in older Australians and increases the risk of harmful interactions, side effects, and inappropriate dosing. Regular review is the key management strategy.
  • A medication review is not a criticism of the prescribing GP. It is a routine quality and safety process that most GPs welcome.

Why Medication Management Is a Safety Issue in Aged Care

Medications are one of the leading causes of preventable harm in older Australians. Falls, hospital admissions, confusion, and functional decline are all linked to medication problems in this population. The reasons are specific and well understood.

Older people are more likely to have multiple chronic conditions, each managed with medications. The average older Australian in residential care takes between eight and twelve different medications. Each additional medication adds to the complexity of management and the risk of interactions.

At the same time, the body changes with age in ways that affect how medications are absorbed and processed. The kidneys and liver, which clear most medications, work less efficiently. This means that doses appropriate for younger adults may accumulate to toxic levels in older people. Medications that were appropriate at 60 may be inappropriate at 80.

Despite this, many older Australians are taking the same medications in the same doses for years, sometimes decades, without anyone reviewing whether the current regimen is still appropriate.

Types of Medication Review Available

Home Medicines Review (HMR)

Home Medicines Review is a Medicare-funded service for people living at home. It involves an accredited pharmacist visiting the person in their home, conducting a structured review of every medication they take (including over-the-counter medications, vitamins, and supplements), and preparing a report with recommendations for the GP.

The review covers:

  • Whether each medication is still indicated for the person’s current conditions.
  • Whether there are interactions between medications that are causing problems.
  • Whether the person understands how to take each medication correctly.
  • Whether side effects that the person is experiencing may be medication-related.
  • Whether doses are appropriate given the person’s age, weight, and kidney function.
  • Whether any medications could be deprescribed, reducing the medication burden without harming the person.

The GP uses the report to make any changes they consider appropriate. The pharmacist does not change medications directly; they advise, and the GP acts.

Eligibility and access: Most people receiving home-based aged care are eligible for HMR. The GP makes the referral. Families who want a review arranged should ask the GP at the next appointment.

Frequency: Once every 12 months as standard, or sooner if there has been a significant change in health status or medications.

Residential Medication Management Review (RMMR)

Residents of aged care facilities receive Residential Medication Management Reviews, which are the equivalent of HMR in the residential setting. These are also conducted by accredited pharmacists and funded through Medicare.

Aged care facilities are required to ensure residents have access to regular medication reviews and that pharmacy services are available to support safe medication management.

Residents or families who want to request a review should speak to the facility’s director of nursing or GP liaison.

GP medication review

Outside of the formal HMR and RMMR programs, a GP can conduct a medication review during a standard consultation. This is less comprehensive than the HMR process because the pharmacist brings specific expertise in drug interactions and medication management that complements the GP’s clinical knowledge.

Some GPs conduct regular medication reviews for older patients proactively. For patients who do not have this happening, requesting it explicitly is appropriate.

When to Ask for a Medication Review

After a hospital discharge

Hospital admission often results in medication changes. New medications are added, existing doses are changed, and some medications may be discontinued. The complexity of managing a changed regimen in the home after discharge is high.

An HMR is specifically appropriate in the first weeks after hospital discharge. The GP can make the referral at the post-discharge follow-up appointment.

After a new diagnosis

When a new chronic condition is diagnosed and a new medication is added, the full medication regimen should be reviewed. A new medication may interact with existing ones, or its addition may create an opportunity to review whether some existing medications are still needed.

After a fall

Falls in older people are frequently medication-related. Sedating medications, blood pressure medications that cause dizziness on standing (orthostatic hypotension), medications that affect balance, and combinations of several such medications all increase fall risk.

If an older person falls, a medication review is one of the first things to request. The review may identify a specific medication or combination contributing to fall risk.

After unexplained cognitive changes

New confusion, memory changes, or behavioural changes in an older person are sometimes attributed to dementia when they are actually medication-related. Anticholinergic medications, benzodiazepines, and many other common medications can cause cognitive changes that are reversible when the medication is stopped or reduced.

Before accepting a new cognitive diagnosis, it is reasonable to request a medication review specifically looking at whether any current medications could explain the change.

When sedation or excessive drowsiness appears

If an older person is sleeping excessively during the day, is difficult to rouse, or is much less alert than previously, this is a sign that something has changed. Medication changes are a common cause.

When medications have been taken for years without review

Long-term use of sleeping tablets, antipsychotics, and some other medication classes is a particular concern. These medications are often started for short-term situations and continued indefinitely without review. Many older people are taking medications that were never intended to be permanent and that carry significant long-term risks.

What to Expect From a Home Medicines Review

A typical HMR involves:

  1. The GP makes a referral to an accredited pharmacist.
  2. The pharmacist contacts the person to arrange a home visit.
  3. The home visit takes 45 minutes to one hour. The pharmacist asks about every medication, how it is taken, any side effects noticed, and the person’s understanding of what each medication is for.
  4. The pharmacist reviews the full list against known interactions and guidelines for older people.
  5. The pharmacist prepares a report with recommendations and sends it to the GP.
  6. The GP reviews the recommendations and discusses any changes with the person at the next appointment.

The pharmacist will want to see all medications, including those in the bathroom cabinet, vitamins, supplements, and anything bought over the counter. Ask the person to gather everything they take, including items they use only occasionally.

What changes might result

Common recommendations from HMR include:

  • Reducing the dose of a medication to a level more appropriate for an older person.
  • Stopping a medication that is no longer indicated or that carries risks exceeding its benefit.
  • Changing the timing of medications to reduce side effects or improve effectiveness.
  • Simplifying a complex regimen through dose administration aid (blister pack) organisation.
  • Identifying a medication that may be causing a symptom the person has been experiencing without it being attributed to the medication.

Not all recommendations will be acted on. The GP makes the clinical decision. But a structured review often identifies problems that routine consultations miss.

Talking to the GP About a Review

Some families are hesitant to ask for a medication review because they do not want to seem critical of the GP or the care being provided. This is not a concern. Medication reviews are a routine quality and safety process. Most GPs welcome them.

The conversation can be straightforward:

“I wanted to ask about organising a Home Medicines Review. [Name] is taking quite a few medications and has had some changes since the last review. Is there anything from the review that concerns you, or would you be happy to refer for an HMR?”

GPs who are not proactively arranging HMR for their older patients are usually not opposed to doing so when a family member asks. The referral is low-effort for the GP and the review is fully funded.

Deprescribing: Reducing the Medication Burden

One of the goals of medication review in older people is deprescribing: the deliberate, supervised process of reducing or stopping medications that are no longer appropriate.

Deprescribing does not mean taking someone off medications indiscriminately. It means reviewing each medication for its current benefit and risk profile, considering the person’s overall health status, goals, and life expectancy, and making informed decisions about which medications to continue, reduce, or stop.

For an older person with limited life expectancy, the calculation of medication benefit and risk changes significantly. Medications taken to prevent cardiovascular events in 20 years may not be appropriate for someone whose primary goal is comfort and quality of life in the near term.

These are conversations that can feel difficult but are important. A GP who has a good relationship with the patient and family can navigate them. A medication review often creates the occasion to have them.

Key External Resources

Carevo connects families with aged care providers who prioritise medication safety and work closely with GPs and pharmacists to support older people. Find a provider who takes medication management seriously.

Frequently Asked Questions

What is a Home Medicines Review? A Medicare-funded pharmacist-led review of all medications taken by a person at home. The pharmacist visits, reviews the full regimen, and reports recommendations to the GP.

Who can request one? The GP makes the referral. Family members or the person receiving care can ask their GP to arrange it at any appointment.

How often can it happen? Once every 12 months as standard, or sooner after a significant health change or hospital discharge.

What reviews are available in residential aged care? Residential Medication Management Reviews (RMMRs) are the equivalent service, also conducted by accredited pharmacists and funded through Medicare.

What are the signs a review is needed? Falls, new confusion, excessive sedation, unexplained symptoms, hospital discharge with medication changes, or long-term use of medications intended for short-term use.

What is polypharmacy and why does it matter? Polypharmacy refers to taking multiple medications simultaneously. Common in older Australians, it increases the risk of interactions, side effects, and inappropriate dosing. Regular review is the primary management strategy.