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

Background: As populations age worldwide, older adults increasingly face polypharmacy and medication adherence challenges. Informal caregivers often assume primary responsibility for medication management, yet their experiences remain underexplored beyond dementia care. Aim: This review aimed to synthesize the experiences of informal caregivers in managing medications for older adults. Methods: A mixed method systematic review was conducted following the Joanna Briggs Institute (JBI) methodology. Four databases (PubMed, CINAHL, PsycINFO and Scopus) were searched for studies published between January 2015 and January 2025. Eligible studies included qualitative, quantitative or mixed methods research addressing medication management by informal caregivers of older adults (≥ 65 years) living at home. Data were qualitized and integrated through a convergent synthesis approach. Results: Sixteen studies met the inclusion criteria, comprising 11 qualitative and five cross-sectional designs across diverse countries. Two integrated findings were identified from the analysis. First, perceiving and enacting medication management responsibilities: caregiver involvement often began after acute health events or functional decline and intensified with increased dependency, especially in co-residing contexts. Their involvement ranged from supervisory support to full responsibility and included obtaining medications, organizing pillboxes, administering doses and monitoring adherence and potential side effects. Medication management was frequently perceived as burdensome, particularly among women, younger caregivers and those managing complex regimens or parenteral therapies. Second, facing and addressing challenges in medication management: caregivers reported difficulties with polypharmacy, complex formulations, patient resistance, systemic barriers and limited access to guidance and support from healthcare professionals. Strategies included pill organizers, reminder systems (e.g., alarms or smartphone apps), handwritten medication lists and individualized routines, though many caregivers reported errors and reliance on unverified information sources. Conclusions: Informal caregivers play a critical yet demanding role in medication management for older adults, often without adequate preparation or support. Their responsibilities span from acquisition to administration and monitoring, placing them at risk of stress, errors and emotional burden. Findings highlight the urgent need for structured interventions providing education, anticipatory guidance and ongoing professional support to strengthen caregiver competence, enhance medication adherence and reduce caregiver burden. Implications for practice: Healthcare professionals should systematically assess informal caregivers' readiness, competencies and support needs related to medication management, recognizing them as key partners in care. Tailored education, medication reconciliation, practical training and clear communication should be integrated into routine care, particularly during care transitions. Structured caregiver support may improve medication safety and adherence while reducing caregiver burden and medication-related errors.