According to a 2024 Australian study, 77% of aged care residents receiving a medication review were prescribed at least one potentially inappropriate medicine (Sawan et al. 2024).

Older people often need to take multiple medicines due to age-related chronic illness, with about 80% of people over the age of 65 having at least one chronic condition (AIHW 2024). However, the physiological processes of ageing make older people more sensitive to the effects of medicines and cause their bodies to respond differently, increasing their risk of experiencing adverse events and interactions (PSA 2020).

Behind every data point is an older person whose cognition, mobility and quality of life are shaped by their medicines, underscoring the need for a person-centred approach that prioritises individual goals, preferences and wellbeing over indicator thresholds alone.

The Aged Care Quality Indicator Program: Medication Management

Inappropriate medicine use has the potential to cause a variety of negative health outcomes, including falls, admission to hospital, adverse drug reactions and even mortality, yet inappropriate prescribing continues to be a widespread and complicated issue in residential aged care (DoHDA 2025a, b).

To address this issue and improve the quality of care for older people, the National Aged Care Quality Indicator Program (QI Program) requires all government-subsidised residential aged care providers to collect and report data on two significant aspects of medication management: polypharmacy and antipsychotics (DoHDA 2025a, b).

The Quality Indicator Program Under the Strengthened Aged Care Quality Standards

Standard 2: The Organisation - Outcome 2.3: Accountability and quality systems under the Strengthened Aged Care Quality Standards (Action 2.3.1) advises registered aged care providers to establish a quality system that uses data from the QI Program to assess the organisation's performance in delivering quality care and services (DoHDA 2025c).

Why The Quality Indicator Program Matters in Practice

While the QI Program defines what must be counted, the real value lies in understanding what the numbers signal. A high rate of polypharmacy does not automatically mean inappropriate prescribing, but it does indicate a population at higher risk of adverse events, functional decline and hospitalisation (DoHDA 2025a, b).

Similarly, antipsychotic use does not always reflect poor practice; however, elevated rates may signal gaps in non-pharmacological approaches, documentation of indication, or review processes. These indicators are therefore best understood as clinical flags that prompt deeper review, multidisciplinary discussion and targeted medication optimisation (DoHDA 2025a, b).

Polypharmacy

Polypharmacy is common among older people, with two-thirds of people aged over 75 taking five or more medicines simultaneously (ACSQHC 2021).

While polypharmacy is necessary in some cases, it carries significant risks and has been associated with serious consequences, including:

Delirium
Falls
Reduced quality of life
Adverse drug reactions
Medicine interactions
Medication errors
Cognitive decline
Admission to hospital
Premature illness or death.

(ACSQHC 2021; DoHDA 2025a, b)

Polypharmacy in the Quality Indicator Program

Under the QI Program, polypharmacy is defined as prescribing nine or more medicines to a single care recipient (DoHDA 2025a, b).

The medicines included in this count are all medicines (both prescription and non-prescription) with an active ingredient, except for:

Lotions, creams and ointments used for skin and wound care
Dietary supplements, including vitamins
Short-term medicines (e.g. antibiotics, temporary eye drops)
PRN medicines
Different dosages of the same medicine.

(DoHDA 2025a, b)

Under the QI Program, residential aged care providers must collect and report data on the number of residents who have been prescribed nine or more medicines (DoHDA 2025a, b). This data collection must take place on a single collection date every quarter (DoHDA 2025a, b).

Providers must review the medication charts and/or administration records of all care recipients and report the following information:

The data collection date for the quarter
The number of care recipients whose records were assessed for polypharmacy
The number of care recipients excluded because they were admitted to hospital on the date of data collection
The number of care recipients who have been prescribed nine or more medicines.

(DoHDA 2025a, b)

Polypharmacy Under the Strengthened Aged Care Quality Standards

Standard 5: Clinical Care - Outcome 5.3: Safe and quality use of medicines under the Strengthened Aged Care Quality Standards (Action 5.3.2) advises registered aged care providers to conduct medication reviews for an older person when polypharmacy is present and potentially deprescribable (DoHDA 2025c).

Antipsychotics

Antipsychotics are a type of medicine intended to treat diagnosed psychosis (e.g. schizophrenia, bipolar disorder, Huntington's disease, delusions and hallucinations, psychosis while receiving end-of-life care) (DoHDA 2025a, b).

Many aged care residents are prescribed antipsychotics in order to manage behavioural and psychological symptoms of dementia (BPSD), despite this practice being contraindicated due to evidence of harm (ACQSC 2020).

Approximately one in five aged care residents is taking antipsychotics. Many of these people are also taking high doses for longer than recommended (PSA 2020; ACQSC 2020).

As well as being potentially harmful, antipsychotics are also unlikely to result in significant benefits when used to manage BPSD (Welberry et al. 2021). Even in cases where antipsychotics are indicated, most people benefit from short-term use only (PSA 2020).

The use of antipsychotics in older adults may be associated with adverse effects such as:

Drowsiness or over-sedation
Confusion
Dizziness
Falls
Delirium
Increased risk of being admitted to hospital for hip fracture or pneumonia
Reduced quality of life
Stroke
Death.

(ACSQHC 2021; PSA 2020; ACQSC 2020)

Antipsychotics in the Quality Indicator Program

Under the QI Program, residential aged care providers must collect and report data on the number of residents who have received antipsychotics (DoHDA 2025a).

The provider must identify a data collection date every quarter. The collection date, and the six days prior to that date, form the seven-day assessment period during which the medication charts and administration records for all care recipients must be assessed for antipsychotics (DoHDA 2025a).

Providers must collect and report the following information:

The data collection date for the quarter
The number of care recipients whose records were assessed for antipsychotics
The number of care recipients excluded because they were admitted to hospital for the entire seven-day assessment period
The number of care recipients who received antipsychotics during the quarter
The number of care recipients who received antipsychotics for medically diagnosed psychosis.

(DoHDA 2025a, b)

Antipsychotics Under the Strengthened Aged Care Quality Standards

Standard 5: Clinical Care - Outcome 5.3: Safe and quality use of medicines under the Strengthened Aged Care Quality Standards (Action 5.3.4) advises aged care providers to establish processes for recognising, assessing and reducing risks to older people who are using high-risk medicines. This includes minimising inappropriate use of psychotropic medicines (DoHDA 2025c).

Using QI Data to Drive Clinical Action

Medication indicators are most powerful when they trigger a structured, person-centred review. QI data becomes meaningful when it informs practice. Some suggestions include where services can:

Prioritise residents triggering one or both indicators for medication review.
Apply structured deprescribing approaches for high-risk or low-value medicines.
Implement antipsychotic review pathways with clear indications, time-limited trials and monitoring.
Embed QI results into clinical governance, MAC meetings and GP communication.

This shifts the program from compliance to active medication optimisation (ACQSC 2025a, 2025b; DoHDA 2025c, 2025d).

Inclusion of an Aged Care Onsite Pharmacist strengthens Residential Aged Care Home (RACH) compliance with the Quality Standards by improving medication safety, leading clinical audits, supporting governance, enhancing documentation, coordinating with prescribers, and embedding person-centred, evidence-based medication practices across the facility. Medication indicators align with broader reforms, including restraint minimisation, high-risk medicines oversight and increased transparency. Together, they reinforce medication safety as a core component of aged care quality and governance (ACQSC 2025a, 2025b; DoHDA 2025c, 2025d).

Limitations

These indicators provide useful oversight but need careful interpretation, as they do not reflect appropriateness or clinical intent, depend on accurate documentation, and are designed to prompt clinical review rather than numerical reduction (DoHDA 2025b).

Conclusion

Polypharmacy and antipsychotic indicators offer valuable insight into medication safety, but their impact depends on how services respond. When paired with pharmacist expertise, multidisciplinary review and person-centred care, these indicators become drivers of safer, more appropriate and more compassionate medicine use in aged care.