How to Simplify Complex Medication Regimens for Older Adults

Imagine taking eight different pills at five different times a day-some with food, some on an empty stomach, others at bedtime. Now imagine doing this every single day, with shaky hands, fading memory, and no one nearby to help. This isn’t rare. It’s the daily reality for hundreds of thousands of older adults in Australia and around the world. Medication regimens have become so complex that they’re undermining the very thing they’re meant to fix: health.

The good news? It doesn’t have to be this way. Medication regimen simplification isn’t about cutting corners-it’s about removing unnecessary friction. Studies show that more than half of older adults on multiple medications can have their regimens simplified without losing clinical benefit. And when it’s done right, adherence improves, falls decrease, hospital visits drop, and people regain a sense of control over their own lives.

Why Complex Regimens Are a Problem

It’s not just about the number of pills. It’s about timing, food restrictions, and the cognitive load of remembering what goes with what. A 78-year-old with high blood pressure, diabetes, arthritis, and mild dementia might be prescribed: one pill for blood pressure at breakfast, another at dinner; a diabetes pill before lunch and another at bedtime; a painkiller three times a day; a statin at night; a vitamin D tablet in the morning; and a thyroid pill on an empty stomach. That’s eight doses across six different times. And each one has rules.

Research from the University of Sydney found that the average older adult in aged care takes five or more medications daily. For those living at home, it’s often just as bad. And here’s the catch: the more doses per day, the less likely someone is to take them correctly. A 2020 study showed that people taking four or more doses a day were 50% more likely to miss a dose than those taking two or fewer. Missed doses don’t just mean symptoms return-they lead to complications, ER visits, and even death.

It’s not laziness. It’s not stubbornness. It’s a system that’s forgotten how humans actually live.

The Three Ways to Simplify

Simplification isn’t guesswork. It’s a structured process with three proven methods:

1. Fixed-dose combinations - Instead of two separate pills, use one pill that contains both drugs. For example, switching from separate lisinopril and hydrochlorothiazide to a single combination tablet cuts two pills down to one. This works well for blood pressure and some diabetes meds.
2. Once-daily dosing - Swap out a twice-daily or three-times-daily pill for a long-acting version. Many blood pressure and antidepressant medications now come in extended-release forms that last 24 hours. Even insulin can sometimes be switched to once-daily basal formulations.
3. Combination approach - Use both strategies together. For instance, replace three pills (one in the morning, one at lunch, one at night) with two: a combo pill at breakfast and a once-daily pill at bedtime.

These aren’t theoretical ideas. In a 2020 trial across 1500 older adults in the U.S., 41% of medication regimens were successfully simplified by reducing daily doses. In Australia, pharmacists using the MRS GRACE tool simplified regimens for 58-60% of aged care residents. The most common change? Reducing the number of times a day someone had to take something. That accounted for 75% of all recommendations.

What Works Best-And What Doesn’t

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

Strong candidates for simplification:

• High blood pressure meds (especially ACE inhibitors and diuretics)
• Some antidepressants and antipsychotics
• Injectable insulins (switching to once-daily basal types)
• Statins (many can be taken at night without food)

Tricky cases:

• Thyroid medication (must be taken on an empty stomach, 30-60 minutes before breakfast)
• Some antibiotics (require strict timing to stay effective)
• Pain meds like NSAIDs (need to be spaced to avoid stomach damage)

Here’s the hard truth: sometimes, the best time to take a drug clashes with the simplest time. A statin works best at night, but if someone only takes meds in the morning because that’s when their caregiver visits, forcing a night-time dose might mean it gets skipped. That’s when simplification needs to be smart-not just mechanical.

The Five-Step Process

Real simplification isn’t a quick fix. It’s a process. Here’s what it looks like in practice:

1. Get the full picture - Start with a ‘best possible medication history.’ This means gathering every prescription, over-the-counter pill, supplement, and herbal remedy the person is taking. Often, GPs and pharmacists have different lists. One study found an average of six discrepancies per patient.
2. Check what’s still needed - Not every medication is still necessary. Deprescribing-stopping drugs that no longer help or may cause harm-is part of simplification. For example, long-term proton pump inhibitors (for heartburn) often get continued long after they’re needed.
3. Look for duplicates - Is someone taking two different blood pressure pills that do the same thing? Are there two different painkillers with the same active ingredient? These are easy wins.
4. Switch to simpler forms - Can a tablet be replaced with a liquid? Can a three-times-daily pill become once-daily? Can two pills become one combo pill? This is where the MRS GRACE tool helps: it asks five clear questions about timing, formulation, and therapeutic alternatives.
5. Involve the person - Don’t assume they want to take everything at breakfast. Maybe they prefer to take meds after lunch because that’s when they feel most alert. Maybe they hate swallowing pills and would rather have a liquid. Their preference matters as much as the science.

This isn’t a one-time event. It’s a conversation that needs to be revisited every few months, especially after a hospital stay or if the person’s health changes.

Who Does This? And How Long Does It Take?

Pharmacists are the most trained to lead this work. In Australia, the Royal Australian College of General Practitioners recommends pharmacists complete a full medication review before simplifying. That usually takes 30 to 60 minutes per person. It’s not quick. But it’s cheaper than a hospital admission.

Many aged care facilities now use the MRS GRACE tool, developed by the University of Sydney. It’s a simple five-question checklist that helps pharmacists spot simplification opportunities. Training takes about two hours. And results? One aged care facility saw a 30% drop in medication administration errors after implementing it.

But here’s the gap: most GPs don’t routinely think about regimen complexity when prescribing. A 2020 review found only 40% of primary care doctors even consider how many pills they’re prescribing. That’s why pharmacist-led reviews are so critical.

What Happens When You Simplify

It’s not magic. But it’s powerful.

In one home care study, older adults who had their regimens simplified reported better adherence-especially those with heart disease. Their blood pressure and cholesterol levels didn’t suddenly improve, but they were more consistent with their meds. That consistency matters. Over time, it reduces stroke risk, kidney damage, and heart failure.

Family caregivers notice it too. One daughter in Melbourne told her pharmacist: ‘I used to spend 45 minutes every morning helping Mum sort her pills. Now she just takes two in the morning and two at night. I can finally breathe.’

And staff in aged care homes? They’re overwhelmed. One nurse said: ‘Before simplification, we’d spend hours just trying to get the meds right. Now we have time to talk to residents instead of just handing out pills.’

That’s the real win: not just better health-but better life.

Barriers and Misconceptions

Not everyone agrees that simplification is safe. Some worry: ‘What if we take away a pill and something goes wrong?’

But the evidence says otherwise. A 2020 study in the Journal of the American Medical Directors Association found that when simplification was done properly-with deprescribing and monitoring-there was no increase in hospitalizations or deaths. In fact, outcomes stayed stable or improved.

Another myth: ‘All meds need to be taken at the exact same time every day.’ Not true. For many drugs, a window of two to four hours is fine. A blood pressure pill taken at 7 a.m. instead of 6 a.m.? No problem. A statin taken at 9 p.m. instead of 10 p.m.? Still effective.

The biggest barrier? Time. Pharmacists are busy. GPs are stretched thin. And Medicare doesn’t yet pay for the kind of in-depth review that simplification needs. But in Germany, pharmacists get reimbursed for doing these reviews. In Australia, the government is slowly moving in that direction.

What You Can Do Right Now

If you’re caring for an older adult with a complicated med list, here’s what to do:

• Write down every pill, supplement, and cream they use-including what time and why.
• Ask their pharmacist for a medication review. Say: ‘Can we look at whether any of these can be simplified?’
• Ask the doctor: ‘Is this medicine still necessary?’ Don’t be afraid to challenge it.
• Use a pill organizer-but only after simplification. A full organizer with 20 compartments is a recipe for confusion.
• Keep a list of medications in your wallet or phone. Update it every time something changes.

And if you’re a health professional? Start asking the five MRS GRACE questions:

1. Can any medications be combined into one pill?
2. Can any be switched to a once-daily formulation?
3. Can any be stopped entirely?
4. Are dosing times realistic for the person’s daily routine?
5. Has the patient’s ability to manage meds been assessed?

It’s not about doing more. It’s about doing less-wisely.

Future of Medication Simplification

Technology is catching up. Epic’s electronic health system now flags complex regimens and suggests simplification options. The University of Sydney is running a trial to see if MRS GRACE can cut medication errors by half in aged care. And more pharmacy schools are starting to teach it.

But the real shift will come when we stop seeing medication management as a technical task-and start seeing it as a human one. People don’t want to be medical technicians. They want to live. And a simpler regimen isn’t just safer. It’s kinder.