Polypharmacy and potentially inappropriate medication use in hospitalized geriatric patients: a prospective evaluation using the American geriatrics society 2023 Beers criteria

Background: Elderly inpatients are disproportionately burdened by polypharmacy and potentially inappropriate medication (PIM) use, driven by age-related pharmacokinetic change, multimorbidity, and fragmented prescribing. Systematic Beers criteria-based prescription review is rarely practised in Indian tertiary care settings, and regional economic data on this problem are lacking. Methods: A prospective observational study was conducted from January-June 2025 at a 1200-bed tertiary care teaching hospital in Raichur, Karnataka, enrolling 100 in-patients aged ≥65 years from general medicine, orthopaedics, ophthalmology, and surgery departments. Prescribed drugs were evaluated against the four categories of the American Geriatrics Society (AGS) 2023 Beers Criteria, and drug costs were used to compute the economic burden of inappropriate prescribing. Descriptive statistics, chi-square, Pearson correlation, and one-way ANOVA were applied. Results: Female patients constituted 61% of the cohort; 57% were aged 65-70 years. Mean drugs per prescription was 11.13±3.72 (range: 5-22). A total of 293 PIM occurrences were identified in 99 of 100 patients (99%); mean 2.93±1.67 per patient. Proton pump inhibitors (40.3%), non-steroidal anti-inflammatory drugs (14.7%), and tramadol (12.6%) were the most prevalent inappropriate classes. Mean PIM-attributable cost was INR 1021.98±1113.04 per patient (13.64% of total inpatient drug expenditure); one-way ANOVA across three cost strata showed significant differences (F=18.87; p<0.001). Conclusions: PIM use was observed in a substantial proportion of elderly inpatients, with proton pump inhibitors, NSAIDs, and opioids frequently identified. The findings support continued individualized medication review, Beers Criteria integration, and physician–pharmacist collaboration to optimize safe, effective, and patient-centered geriatric pharmacotherapy.