Challenges and Strategies of Informal Caregivers in Medication Management for Older Adults: A Mixed Method Systematic Review.

TL;DR

Informal caregivers shoulder the full weight of medication management for older adults without systematic preparation or professional support, creating high risk for errors and caregiver burnout. Healthcare systems need structured education, medication reconciliation, and ongoing guidance integrated into routine care to address this critical gap.

What the Study Found

A systematic review of 16 studies published between 2015 and 2025 examined how informal caregivers (adult children, spouses, and other family members) manage medications for older adults living at home. The research synthesized 11 qualitative studies and five cross-sectional designs across multiple countries, revealing a consistent pattern: medication management has become a primary caregiving responsibility that often goes unrecognized and unsupported by healthcare systems.

The research identified a clear progression of caregiver involvement. Medication management responsibilities typically begin after an acute health event or noticeable functional decline in the older adult, then intensify as dependency increases. Co-residing caregivers (those living with the older adult) tend to assume more extensive responsibility. The scope of their work is substantial, ranging from obtaining medications and organizing them into pillboxes to administering doses, monitoring adherence, and watching for side effects. For some caregivers, this means managing complex medication regimens with multiple daily doses, different formulations, and specialized administration methods like injections.

The burden falls disproportionately on certain groups. Women reported higher perceived burden than men, and younger caregivers reported greater strain than older ones. Those managing polypharmacy (multiple medications) and parenteral therapies (injections or infusions) experienced particularly acute stress. Many caregivers described their role as burdensome, yet healthcare professionals often did not formally assess their readiness or provide structured preparation for these responsibilities.

Caregivers encountered substantial practical challenges. Polypharmacy created confusion about which medications served which purpose and how they interacted. Complex formulations (different pill sizes, shapes, and administration timing) increased the cognitive load. Patient resistance to taking medications complicated adherence efforts. Systemic barriers like pharmacy coordination issues and limited access to healthcare guidance meant caregivers were often left to solve problems independently. Many reported gaps in knowledge about medication interactions, side effects, and proper administration techniques. When they sought information, caregivers frequently relied on unverified sources like internet searches rather than healthcare professionals.

To manage these challenges, caregivers employed practical strategies: pill organizers and reminder systems (alarms, smartphone apps), handwritten medication lists, and individualized routines built around daily activities. However, these self-designed systems were frequently error-prone, and caregivers lacked confidence that they were implementing them correctly. The systematic review concludes that informal caregivers play a critical, demanding role in medication management without adequate preparation or ongoing professional support, placing them at risk of stress, emotional burden, and medication errors that could directly harm the older adults they care for.

What This Means for You

If you are an adult child or family member managing medications for an aging parent or relative, several evidence-based strategies can help reduce errors and burden:

Seek formal medication reconciliation from healthcare providers. Before taking on medication responsibilities, request a comprehensive review of all medications, supplements, and over-the-counter products your family member is taking. Ask the pharmacist or physician to explain the purpose, timing, and potential interactions for each medication. Write this down or take notes on your phone during the conversation.

Create a structured system. The evidence shows that pill organizers and reminder systems significantly reduce errors. Weekly pill organizers purchased from any pharmacy are inexpensive and effective. Pair this with phone alarms, calendar reminders, or medication management apps to signal dosing times. This removes reliance on memory alone.

Request written, clear communication from all healthcare providers. Ask for medication lists from every clinician involved in your family member's care. Pharmacy communication gaps were a common challenge in the research. Consider using a single pharmacy for all prescriptions when possible to enable better oversight of interactions and duplications.

Don't rely on unverified information sources. When you have questions about medications, side effects, or interactions, contact the pharmacist or prescribing physician directly. They are your most reliable information source, not internet searches or health forums.

Advocate for professional support and education. The evidence indicates that structured caregiver education and anticipatory guidance reduce errors and burden. Request this from your healthcare team. Ask about medication management education programs, written instructions specific to your situation, and scheduled follow-up conversations about how the regimen is working.

Monitor for burden and stress in yourself. The research identifies that caregiving stress is real and significantly impacts quality of life. If you feel overwhelmed, communicate this to healthcare providers. Respite care, support groups, and delegation of some tasks (such as pharmacy delivery services) can provide relief.

Build individualized routines. Tie medication administration to established daily activities (breakfast, lunch, dinner, bedtime) to integrate it into existing habits rather than treating it as a separate task.

Study Details

Sources

Systematic review examining informal caregiver experiences in medication management for community-dwelling older adults: PubMed 42434829