How to Simplify Complex Medication Regimens for Older Adults

More than half of adults over 65 take five or more medications daily. For many, that means juggling pills at breakfast, lunch, dinner, and bedtime-with some requiring empty stomachs, others needing food, and a few only at night. It’s no wonder so many miss doses or take the wrong pill. The good news? Medication simplification isn’t just possible-it’s proven to help older adults stay independent, safer, and more in control of their health.

Why Complex Medication Regimens Are a Problem

It’s not just about too many pills. It’s about timing. A typical regimen might include:

• Levothyroxine on an empty stomach, 30 minutes before breakfast
• Metformin with breakfast and dinner
• Atorvastatin at bedtime
• Losartan in the morning
• Aspirin after lunch
• Acetaminophen as needed for pain
• Three different eye drops at different times

That’s seven different times a day to remember. Add in a pill organizer with 28 compartments, and it’s easy to see why confusion sets in. Studies show that when older adults have more than four daily doses, adherence drops sharply. And when they miss doses, hospitalizations go up-especially for heart failure, diabetes, and high blood pressure.

But here’s the thing: most of these medications aren’t actually being taken correctly-not because the person doesn’t care, but because the system is too complicated.

What Medication Simplification Actually Means

Simplification doesn’t mean stopping meds. It means making them easier to take-without losing their benefit. There are three main ways this happens:

1. Combining pills into one tablet (like a pill that has both a blood pressure and cholesterol drug)
2. Switching to once-daily versions (like switching from twice-daily metoprolol to once-daily metoprolol succinate)
3. Aligning doses with daily routines (like grouping all morning meds together)

One study in Australian aged care homes found that 58% to 60% of residents had regimens that could be simplified using a simple five-question tool called MRS GRACE. The biggest win? Changing when pills were taken-not always changing the pills themselves.

For example, if someone takes a diuretic at night, they might wake up to use the bathroom three times. Switching it to the morning reduces sleep disruption and makes it easier to remember. Same drug. Better timing.

What Works Best-and What Doesn’t

Not all medications respond the same way to simplification. Some are more flexible than others.

Good candidates for simplification:

• High blood pressure meds (many now come in once-daily forms)
• Cholesterol-lowering drugs (like statins-most can be taken anytime, even with food)
• Diabetes pills (some can be switched to once-daily extended-release versions)
• Antidepressants and antipsychotics (long-acting versions exist and reduce dosing frequency)

Tricky cases:

• Levothyroxine (must be taken alone, on an empty stomach, 30 minutes before food)
• Insulin (timing matters for blood sugar control)
• Some antibiotics (need strict timing to stay effective)

Here’s the catch: even when simplification improves adherence, it doesn’t always mean better health outcomes. Why? Because older adults often have multiple conditions. Taking a pill on time doesn’t fix a poor diet, lack of exercise, or untreated depression. But it does remove one big barrier to staying well.

The Step-by-Step Process

Real simplification isn’t a quick fix. It’s a careful process. Here’s how it works in practice:

1. Get the full list-not what the person remembers, not what’s on the bottle. A pharmacist or GP should compile a ‘best possible medication history’ by checking prescriptions, hospital records, and even over-the-counter meds. On average, people have six errors or omissions in their medication list.
2. Check what’s still needed-some meds may no longer be necessary. Maybe a painkiller was prescribed for a back injury that healed years ago. Maybe a blood thinner is no longer needed after a heart procedure. This step is called deprescribing.
3. Look for combo pills-ask if there’s a single tablet that combines two drugs. For example, a combo of lisinopril and hydrochlorothiazide replaces two separate pills.
4. Switch to once-daily versions-many meds now have extended-release forms. Ask if the current version can be changed.
5. Group by time of day-move all morning meds to one time, all evening meds to another. Even if you can’t reduce the number of pills, reducing the number of times you take them makes a huge difference.

This whole process usually takes 30 to 60 minutes per person. That’s why many GPs don’t do it-they’re pressed for time. But pharmacists, especially those trained in geriatric care, are the best people to lead this.

Real Impact: What Happens When You Simplify

In a 2020 study of community-dwelling older adults in the U.S., 41% of medication regimens were successfully simplified just by reducing how many times a day pills had to be taken. In Australian aged care homes, staff reported a 30% drop in medication errors after using the MRS GRACE tool.

One woman in Perth, 78, was taking 14 different medications across six times a day. After a pharmacist review, she was switched to:

• One combo pill for blood pressure and cholesterol (morning)
• One once-daily diabetes pill
• One daily aspirin
• One levothyroxine (still on empty stomach, but now just one pill)

She went from 14 pills, six times a day, to 4 pills, two times a day. She started taking them regularly. Her blood pressure improved. She didn’t have to refill her pill box every week. And she said, ‘I finally feel like I’m in charge again.’

Who Should Be Doing This?

It’s not just the doctor’s job. It’s a team effort:

• Pharmacists are the experts in medication timing, interactions, and alternatives. They’re trained to spot simplification opportunities.
• General practitioners need to refer patients for medication reviews, especially if they’re on five or more meds.
• Family caregivers can help by tracking what pills are taken, when, and whether side effects appear.
• The person taking the meds needs to be part of the conversation. Do they prefer to take everything in the morning? Do they hate swallowing pills? Their preferences matter.

There’s a tool called MRS GRACE that’s now used in Australia and being adopted in the U.S. and Europe. It’s not software-it’s a simple five-question checklist:

1. Can any doses be moved to the same time of day?
2. Are there combination products available?
3. Can any medications be switched to once-daily forms?
4. Are any medications no longer needed?
5. Has the patient’s ability to manage meds changed?

Healthcare providers can learn it in under two hours. But most still don’t use it-because no one’s asking them to.

Barriers and How to Overcome Them

Even though simplification works, it’s not common. Why?

• Time-most GP visits are 10 minutes. A full med review takes 45.
• Cost-in many places, pharmacists aren’t paid to do these reviews.
• Training-only 35% of pharmacy schools teach this skill.
• Assumption-many doctors assume older adults can handle complexity, or that they’ll just ‘figure it out.’

Here’s how to push for change:

• Ask your pharmacist: ‘Can you do a medication review?’
• Ask your GP: ‘Is there a simpler way to take these?’
• Use a pill organizer with alarms or a smartphone app (like Medisafe or MyTherapy) to track what’s taken.
• Bring all meds-bottles, supplements, creams-to every appointment.

And if you’re a caregiver: don’t assume the person is taking their meds correctly. Watch them. Ask them to show you. It’s not about distrust-it’s about safety.

What’s Next?

Technology is catching up. Electronic health records now include tools that flag complex regimens. Epic Systems, one of the biggest health record platforms, has a feature that scores how complicated a patient’s regimen is and suggests simplifications.

But tech alone won’t fix this. It needs people-trained, paid, and empowered-to do the work. In Germany, pharmacists get paid extra for doing these reviews. In Australia, the government is pushing for it to be part of standard aged care. In the U.S., Medicare Advantage plans are starting to reward providers who reduce hospital readmissions linked to medication errors.

The goal isn’t to cut pills. It’s to cut confusion. To give older adults back their time, their dignity, and their independence.

Medication simplification isn’t a luxury. It’s a necessity for an aging world. And it starts with one question: ‘Is there a simpler way?’