Evaluation of Polypharmacy and Potentially Inappropriate Medication Use Among Older Adults Attending a Tertiary Care Centre: A Cross-Sectional Pharmacological Assessment

Abstract

Background: Older adults frequently have multiple chronic conditions requiring treatment with several medications. Although appropriate polypharmacy may be clinically necessary, an increasing medication burden can increase the risk of drug-related problems, drug–drug interactions, adverse drug events, and potentially inappropriate medication (PIM) use. Systematic evidence from India indicates that polypharmacy and PIM use are common among older adults, highlighting the importance of structured medication review.

Objective: To evaluate the prevalence of polypharmacy and potentially inappropriate medication use among older adults attending a tertiary care centre and to identify factors associated with PIM use.

Methods: A hospital-based cross-sectional observational study was conducted from February 2024 to January 2025 among 300 patients aged ≥65 years attending the Department of General Medicine of a tertiary care centre. Demographic characteristics, clinical diagnoses, comorbidities, and prescribed medications were recorded using a structured data collection form. Polypharmacy was defined as the concurrent use of five or more medications, while hyperpolypharmacy was defined as the use of ten or more medications. Potentially inappropriate medications were identified using the 2023 American Geriatrics Society (AGS) Beers Criteria. Drug–drug interactions were assessed using an established drug-interaction reference. Descriptive statistics and appropriate inferential tests were used. Multivariable logistic regression was performed to identify factors independently associated with PIM use.

Results: Among 300 participants, 172 (57.3%) were males and 128 (42.7%) were females. The mean age was 71.8 ± 6.7 years. Polypharmacy was observed in 187 (62.3%) participants, while hyperpolypharmacy was present in 54 (18.0%). At least one potentially inappropriate medication was identified in 96 (32.0%) participants. The prevalence of PIM use increased with increasing medication burden and number of comorbidities. The most frequently identified PIM categories included medications requiring caution in older adults, drugs with strong anticholinergic properties, selected central nervous system medications, and medications requiring avoidance under specific clinical conditions. PIM use was significantly associated with polypharmacy, hyperpolypharmacy, and the presence of multiple comorbidities.

Conclusion: Polypharmacy and potentially inappropriate medication use were common among older adults attending the tertiary care centre. Increasing medication burden and multimorbidity were associated with a greater likelihood of PIM exposure. Structured medication review using standardized criteria such as the AGS Beers Criteria may help identify potentially problematic prescribing and support safer pharmacotherapy in older adults.