OBJECTIVE: To describe and compare medication-taking behaviors in the high- and low-functioning elderly living in the community. DESIGN: A cross-sectional design with data collected by interview. SETTING: The study included 5 counties in the southern Piedmont area of North Carolina. PARTICIPANTS: Respondents included 242 elderly aged 70-79 years selected from the Piedmont Health Survey of the Elderly and the MacArthur Research Program on Successful Aging. MAIN OUTCOME MEASURES: Outcome measures included strategies used to remember to take drugs, reasons given for skipping medications, factors associated with understanding of drugs, the number of over-the-counter and prescribed drugs used, and the number of drugs used in therapeutic categories. RESULTS: Low-functioning elderly white respondents took greater numbers of prescribed drugs than did blacks or high-functioning whites. Respondents had a better understanding of prescribed than of over-the-counter drugs, with the poorest understanding of nutritional supplements. Men and blacks had poorer understanding of drugs than women and whites. The strategies subjects used to remember to take drugs included (from most to least frequently used): making it a routine activity, reading labels, a self-devised memory aid, a habit, being reminded by someone else, sorting, and noticing symptoms. CONCLUSIONS: Clinicians should provide their patients with information about over-the-counter agents as well as prescribed drugs, be alert to cues that blacks and men give indicating their need for additional explanation about a drug's purposes, and be sensitive to differential prescribing patterns with respect to race. When planning a regimen for multiple doses of a drug, clinicians should account for their patients' tendencies to use routine activities as memory prompts.