Background:Polypharmacy, usually described as ≥5 daily medications, is common among older Australians (≥65 years) and is associated with higher healthcare costs related to adverse drug events, inappropriate medication use and poor health outcomes. Little is known about how older adults consider risk in relation to the use of polypharmacy.Methods:A convenience sample of independent, community living older adults from regional NSW, Australia aged ≥65 years, taking ≥five medications, were invited to take part in individual one-on-one interviews between August 2017 and October 2018. The qualitative interviews were audio recorded and transcribed verbatim, coded and analysed thematically using NVivo 12. Results:In total, 25 older adults participated in the study. They had a median age of 79 (range 69-95) and took a median of 10 medications (range 5-25). Older adults weigh-up the impact on quality of life from current side effects, versus current or future therapeutic gain. They are aware of potential future harms. They draw on knowledge sources based on their own or other’s experience of benefit from medication use to inform their decision making however trust their prescribers to manage risk on their behalf.Conclusion:Older adults practice a range of health literacy strategies that enable them to understand the risk of polypharmacy use. However they defer decision making to their prescribers to assess overall risk. Prescribers need to actively assess ongoing benefits v’s harm with a view to discontinuing medications where possible and invite older adults to contribute their own views of risk.