OBJECTIVES: To determine the sociodemographic characteristics, health conditions, and cognitive and functional status associated with baseline prevalence and new need for help taking medication 3 years later and to construct a brief scale indicative of need for help taking medications. DESIGN: Retrospective cross-sectional and 3-year longitudinal study. SETTING: Five-county area in north-central Piedmont, North Carolina. PARTICIPANTS: Representative community-dwelling sample of black and white individuals aged 65 and older (N = 4,136). MEASUREMENTS: Information was obtained in person in participants' homes using structured questionnaires. Health conditions included sensory impairment and self-report of physician-diagnosed conditions. Cognitive status was assessed using the 10-item Short Portable Mental Status Questionnaire. Functional status was assessed using the three-item Rosow-Breslau scale, the five-item Katz activity of daily living scale, and a modified six-item Older Americans Resources and Services instrumental activities of daily living scale. RESULTS: Characteristics associated with need for help taking medications were aged 80 and older, being male, living with others, having four or more chronic conditions, and impaired cognitive or functional status (c-statistic 0.94, 77.1% sensitivity, 87.9% specificity). Predictors of new need for help with medications 3 years later included aged 75 and older at baseline, being male, and impaired cognitive and functional status (c-statistic 0.75). CONCLUSION: This brief scale can help identify persons needing help with medications and could be useful in assisting clinicians with medication management.