Drug-related problems are common among elderly. The current study aimed to provide an overall picture of medication management by home-dwelling elderly with chronic diseases, by examining: (1) drug utilization, (2) drug adherence, (3) drug knowledge and (4) practical drug management capacity. Such integrated view should allow us to identify potential problems and to indicate target areas for community pharmacist intervention. Cross-sectional, observational study in 86 community pharmacies (Belgium). The patients' current chronic medication regimen was taken from the pharmacy database. Drug adherence was determined by prescription refill rate, pill count and self-report. Drug knowledge and practical drug management capacity were assessed by questionnaire. The study population (n=338) used a median of 5 chronic drugs per patient. Half of our sample chronically used psychotropic medication, mainly benzodiazepines. In 100 patients (29.6%) at least one drug-drug interaction of potential clinical significance was observed. The overall mean adherence per patient was very high: 104.8% according to prescription refill rate and 98.1% according to pill count. Most patients (95.9%) self-reported to take their medicines according to the GP's instructions, although nearly one fifth (n = 82) admitted forgetting medicine intake occasionally. Moreover, 16.9% (n = 57) admitted having stopped a medication on their own initiative. Seventy-six % (n=258) of patients had an acceptable knowledge of the indication for at least 75% of their medication. The participants reported several practical drug taking problems: difficulties with vision (32.0%), blister opening (12.1%), tablet swallowing (14.8%), tablet splitting (29.7% [represents % of patients who have to split tablets]) and distinction between different drug packages (23.4%). These data should allow us to design a rational community pharmacist intervention for this vulnerable patient group.