Medication refusal in residential aged care homes: A qualitative exploratory study

Background In Residential Aged Care Homes (RACHs), medication administration is typically carried out by aged care workers, rather than being under the control of older adults. Very little empirical qualitative evidence exists around situations where medication is refused by older adults. Research aim To explore aged care workers’, older adults’, and family members’ perspectives and experiences of medication refusal in RACHs. Research design A qualitative exploratory study design. Participants and research context Between November 2024 and May 2025, participants were purposively recruited from two RACHs, and through a peak consumer group for people living with dementia and their families. Semi-structured interviews were conducted with aged care workers (n = 10), older adults living in aged care (n = 9), and family members of older adults (n = 7). Data were analysed using Braun and Clarke’s reflexive thematic analysis. Ethical considerations Interview participation was voluntary, with either written or verbal consent obtained, depending on participants’ preferences. Identities were replaced with participant type and a numerical code. This study was approved by the Monash University Human Research Ethics Committee (MUHREC) (ID 41475). Findings Three themes and four subthemes were developed regarding medication refusal in RACHs. These themes encompassed: (1) ‘Voices from different corners: medication refusals as more than just saying “no”’; (2) ‘the tightrope of role obligations – doing good, respecting choice, and avoiding harm’; and (3) ‘Competent to say yes, but not to say no: the erosion of the right to refuse’. Conclusions Medication refusals in RACHs are clinically and ethically challenging for aged care workers, who use a variety of well-intentioned strategies to respond to these events. Given the complex nature of medication refusals, it is important that aged care workers take older adults’ decisional competence into consideration, balancing respect for autonomy with beneficence and best interests decision-making.