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Objective: To describe medication-related quality of care (MRQOC) for Australian aged care residents.Design: Retrospective cohort using an administrative healthcare claims database.Setting: Australian residential aged care.Participants: A total of 17 672 aged care residents who were alive at 1 January 2013 and had been a permanent resident for at least 3 months.Main Outcome Measures: Overall, 23 evidence-based MRQOC indicators which assessed the use of appropriate medications in chronic disease, exposure to high-risk medications and access to collaborative health services.Results: Key findings included underuse of recommended cardiovascular medications, such as the use of statins in cardiovascular disease (56.1%). Overuse of high-risk medications was detected for medications associated with falls (73.5%), medications with moderate to strong anticholinergic properties (46.1%), benzodiazepines (41.4%) and antipsychotics (33.2%). Collaborative health services such as medication reviews were underutilised (42.6%).Conclusion: MRQOC activities in this population should be targeted at monitoring and reducing exposure to antipsychotics and benzodiazepines, improving the use of preventative medications for cardiovascular disease and improving access to collaborative health services. Similarity of suboptimal MRQOC between Australia and other countries (UK, USA, Canada and Belgium) presents an opportunity for an internationally collaborative approach to improving care for aged care residents. [ABSTRACT FROM AUTHOR]