Background <p>Returning home from the hospital is a critical timepoint for medication management among older adults (adults aged 60 years or over) with coronary artery disease. Older adults experience changes in their medication regimens, and a shift from supervised medication management to self-management, leading to a higher risk of medication discrepancies. However, limited studies are available to understand the changes in their perceptions about medication management. This study aims to explore the changes in perceptions about medication management among older adults with coronary artery disease transitioning from hospital to home.</p> Methods <p>A longitudinal qualitative study was conducted with a purposive sample of older adults with coronary artery disease (<i>n</i> = 28) and caregivers (<i>n</i> = 10), during June to September 2024. Older adults participated in interviews before and one month after hospital discharge to home. Semi-structured interviews were conducted regarding the older adults’ and caregivers’ perceptions of medication management. Data was analysed using thematic and framework analysis.</p> Results <p>Two themes along with five sub-themes were developed, including: (1) Theme 1. From compliance to engagement in medication management: Sub-theme (1) Feeling compelled to accept to take the medications by disease, Sub-theme (2) Leaving health to the healthcare professionals; (2) Theme 2. Struggling in balancing the benefits and risks of medications: Sub-theme (1) Evolving understanding about the benefits of medications, Sub-theme (2) Predominant concerns about adverse drug events, Sub-theme (3) Indecisiveness in maintaining adherence. The views of older adults and caregivers were consistent across the themes.</p> Conclusion <p>Changes in perceptions about roles, disease and medications were observed among older adults with coronary artery disease transitioning from hospital to home. Older adults simply followed instructions, but shifted to independent administrators after discharge. They accepted to take medications after discharge, as perceiving consistent threat of coronary artery disease. They had evolving understanding in the benefits and risks of medications and struggled in balancing them. More patient-centered and culturally sensitive interventions are warranted for future research. Providing continuous support in medication management, developing positive perceptions of mild side effects and skills in addressing severe side effects, and involving caregivers are important strategies to optimise medication management.</p>