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Background Polypharmacy, defined as the concurrent use of five or more medications, is prevalent among older adults, particularly those receiving home care. This population faces an increased risk of adverse drug reactions (ADRs) and medication-related complications due to frailty, multimorbidity, and socio-economic disparities. Despite a growing number of older adults relying on home care, there is limited UK-based evidence on prescribing patterns and their associations with health outcomes. Understanding these patterns is crucial to inform policy and optimise medication management in the UK home care setting.Methods A cohort study was designed using Clinical Practice Research Datalink (CPRD) data, linked with Hospital Episode Statistics (HES) and the Index of Multiple Deprivation (IMD). Statistical analyses included descriptive statistics, Pearson’s correlation, linear regression, and ANOVA to assess relationships between polypharmacy severity, age, gender, ADRs, hospitalisations, and socio-economic status. Additional subgroup analyses will explore disparities across regional and demographic variations. Patient and public representatives, including care providers and recipients, informed the study design at all stages to ensure relevance and applicability to real-world care settings.Results Preliminary findings indicate that polypharmacy is highly prevalent among older adults receiving home care in England, with 53% experiencing polypharmacy and 15% meeting criteria for hyperpolypharmacy (10+ medications). Medication use increases with age but plateaus in individuals aged 85+. Preliminary findings indicate that polypharmacy severity varies by age group, with the 65–74 category showing the highest average medication count, while those aged 85+ show a slight decline, suggesting possible de-prescribing practices in this age group. Statistical analyses suggest significant associations between polypharmacy severity and age (p < 0.001), but with a weak correlation coefficient (-0.086), indicating age alone is not a strong predictor. Gender differences were observed, with males taking slightly more medications than females (p = 2.8e-13), though the effect size was minimal. Further analyses will explore associations with ADRs, hospitalisations, and socio-economic disparities.Conclusion This study highlights the high prevalence of polypharmacy among older adults receiving home care in England, particularly among those with multimorbidity and socio-economic disadvantages. Findings suggest the need for targeted interventions to optimise prescribing practices and reduce medication-related risks in this vulnerable population. Future research will investigate the impact of polypharmacy on health outcomes and inform policy initiatives aimed at safer prescribing in home care settings. By incorporating patient and provider perspectives, this work will ensure that findings translate into meaningful changes in practice, ultimately improving medication safety and healthcare outcomes.