Background: Transitions of care pose significant medication safety risks for older adults. Understanding current levels of patient engagement in medication management may inform strategies to improve patient and healthcare outcomes. Aim: To identify the types of interventions used by older adults and the extent of their engagement in medication management during transitions of care. Methods: A mixed-methods systematic review was conducted. Six electronic databases were searched for qualitative, quantitative, and mixed-methods studies from inception to April 2024. Engagement interventions were categorised using the Ladder of Patient and Family Engagement¹, which classifies engagement from level 1 (informing) to level 5 (full integration and partnership). Results: Twenty-five studies were included. Most interventions were low-level (levels 1–2; n=19, 76%) and primarily involved passive information provision by healthcare professionals. Higher-level engagement interventions (levels 3–4) were less frequent (n=6, 24%). Both low-level (OR 0.84, 95% CI [0.73–0.97], p=0.02) and high-level (OR 0.63, 95% CI [0.50–0.80], p<0.0001) engagement interventions were associated with statistically significant reductions in hospital readmissions. High-level interventions were consistently associated with improved longer-term patient and healthcare outcomes. No studies demonstrated full patient integration (level 5). Conclusions: While both low- and high-level engagement interventions reduced hospital readmissions, high-level approaches yielded more sustained benefits but were resource-intensive and constrained by workforce limitations. Interventions extending beyond discharge, such as follow-up contact, were particularly effective. The absence of level 5 interventions highlights a significant gap and missed opportunities for integrated, patient-centred care. Reference: 1. Kim JM, Suarez-Cuervo C, Berger Z, et al. Patient. 2018;11(2):193–206.