OBJECTIVE: To examine decision-making between healthcare providers (HCPs), older people and their carers in relation to medication management. METHODS: Four databases were systematically searched up to June 2023. Two authors screened the search results. Extracted quantitative data were analysed descriptively, and qualitative data were analysed thematically. RESULTS: Fifty-three papers reporting on 49 studies were included. A variety of research methods were utilised. Few authors provided a definition of shared decision-making (SDM). Three major themes were identified: provider-driven decision-making, patient-driven decision-making and a shared role in decision-making. Some older people preferred or deferred to provider-driven decision-making, mainly due to trust in the HCP's expertise. Other reasons for provider-driven decision-making were patient anxiety, declining health, lack of medical knowledge or poor communication during the clinical encounter. Evidence of patient-driven decision-making was often prompted by concerns about the adverse effects of medication. Most older people preferred or adopted a shared role in decision-making. CONCLUSION: Whilst most patients and carers preferred to engage in SDM related to medication management, at times, they felt unable to do so, deferring to provider-driven decision-making. There is a need for a standardised definition and measurement of SDM. PATIENT OR PUBLIC CONTRIBUTION: This systematic review did not directly involve older people or carers of older people in the design or conduct of the review. However, the findings will inform a qualitative study aimed at exploring older people and their carers' experiences of medication-related decision-making in collaboration with their healthcare provider. TRIAL REGISTRATION: CRD42019124862.