Potentially inappropriate medication use and selected drug-related problems among older adults in Aseer Region, Saudi Arabia: a retrospective multicenter study

Older adults are at increased risk of medication-related safety concerns due to multimorbidity and polypharmacy. Potentially inappropriate medications (PIMs) and drug-related problems (DRPs) are important contributors to medication safety concerns in this population, yet hospital-based data from Saudi Arabia remain limited. This study aimed to evaluate the prevalence and patterns of PIM use among older adults in the Aseer region of Saudi Arabia using the 2023 American Geriatrics Society (AGS) Beers Criteria. Secondary objectives were to identify selected drug-related problems (DRPs) and examine factors associated with PIM exposure. A retrospective multicenter medical record review was conducted among adults aged ≥ 65 years receiving care at two public hospitals in the Aseer region. Data abstraction from electronic and paper-based medical records was conducted between August and December 2023. Polypharmacy and hyperpolypharmacy were defined as the use of ≥ 5 and ≥ 10 medications, respectively. PIMs were identified using selected criteria from the 2023 AGS Beers Criteria that could be reliably evaluated from the available medical-record information, including applicable duration- and context-dependent criteria. Selected DRPs were assessed using predefined operational criteria. Descriptive and inferential statistical analyses were performed, including multivariable binary logistic regression to examine factors associated with PIM exposure. Among 377 patients (mean age 77.4 ± 9.3 years), 206 patients (54.6%) had at least one PIM and 48 patients (12.7%) had two or more PIMs. Prolonged proton pump inhibitor use was the most frequently identified PIM. Polypharmacy was present in 259 patients (68.7%). In multivariable analysis, polypharmacy remained associated with PIM exposure after adjustment for measured demographic, clinical, hospital, and care-setting characteristics (aOR 3.13, 95% CI 1.78–5.52; p < 0.001). PIM use was common among older adults in this hospital-based cohort in the Aseer region. Polypharmacy remained associated with PIM exposure after adjustment for measured covariates, supporting the importance of structured medication review and optimization among older adults with high medication burden.