Introduction Various assessment criteria, like Beers, STOPP/START, and country-specific guidelines have been developed to identify potentially inappropriate medications (PIMs) to ensure safer prescribing practices. However, their implementation in community settings faces challenges, mainly because these criteria primarily focus on hospitalized or nursing facility residents and often require comprehensive clinical information. To overcome these challenges, a novel medication review tool for Korean community-dwelling older adults, comprising 81 items across five domains, was developed. This pilot study was conducted to evaluate the feasibility of applying this tool in a real-world community pharmacy setting. Methods Ten community pharmacies across South Korea, involving 15 pharmacists were recruited. Eligibility criteria required participants to be older adults aged 65 or older who were regular visitors to these pharmacies. Additionally, participants needed to meet at least one of the following conditions: taking 5 or more medications regularly; have been discharged from a hospital within the past month while taking at least one medication; receiving prescriptions from 3 or more different doctors; taking medications that require caution; or using over-the-counter medication more than once a week. Pharmacists collected medication history using prescriptions, the \'My Prescriptions Medication! At a Glance\' service, and interviews, identifying PIMs and drug-related problems (DRPs), and making necessary interventions or recommendations. Follow-up assessments were conducted during subsequent pharmacy visits to monitor changes in medication regimens. Results The study enrolled 32 participants, with an average age of 74.3. Females comprised 59.4% of the sample. Participants, on average, took 11.6 chronic medications, with 65.3% being on more than 10 medications. In addition, they had an average of 1.2 as-needed (PRN) medications. When applying the Korean Medication Review Tool, 78.1% of participants were taking at least one PIM with an average of 2.9 PIMs each. Male participants had more PIMs than females (3.4 PIMs vs. 2.6 PIMs), and the 65-69 age group had the highest prevalence of PIMs (4.8 PIMs per person). Pharmacists identified 106 DRPs in 19 participants (90.6%), with the most common issues being potentially inappropriate medication use, duplication (21.7%), and drug-drug interactions (14.2%). Attempts to intervene were made in 86.8% of the identified DRPs, with prescription interventions and patient education being the primary methods. Acceptance rates for prescriptions and patient education were 49.1% and 70.3%, respectively. Conclusion This pilot study demonstrated the practical application of a newly developed medication review tool in real-world community pharmacies to enhance pharmaceutical services and healthcare quality for community older residents. It revealed that nearly 80% of community-dwelling older adults are at risk of taking at least one PIM based on the Korean tool, highlighting the tool’s potential to improve medication safety.