Medication adherence is a critical component of effective healthcare, particularly among the elderly who often face challenges such as polypharmacy, cognitive decline and multiple chronic conditions. Non-adherence to a therapeutic regimen may result in negative outcomes for the patient and may be exacerbated in them with co-morbidities that require multiple drug therapy. A prospective cohort study was conducted over six months from November 2022–April 2023 involving elderly participants aged more than 60 years from Mysuru residents and various outpatient departments of JSS Hospital. Data was collected from two groups those with caregivers and without caregivers. Medication adherence was assessed using the Medication Adherence Rating Scale (MARS). Non-adherent participants from the group without caregivers received counselling and were reassessed after two months. Out of 287 participants, 108 had caregivers and 179 did not have caregivers. Adherence was significantly higher among those with caregivers (76.85%) compared to those without (44.13%). After counselling, adherence in the previously non-adherent group improved markedly, with 51 out of 100 showing better adherence. Caregivers play a crucial role in enhancing medication adherence among the elderly. Patient counselling proved effective in improving adherence. Interventions focusing on caregiver involvement and consistent patient education are essential for optimal medication management in geriatric populations.