POTENTIALLY INAPPROPRIATE MEDICATION USE AND ASSOCIATED FACTORS AMONG GERIATRIC PATIENTS HOSPITALIZED WITH CARDIOMETABOLIC DISORDERS IN PUBLIC HOSPITALS OF EASTERN ETHIOPIA; A MULTI-CENTER PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background: Potentially inappropriate medications (PIMs) are drugs where the risks of taking them are more than the benefits or where safer alternatives exist. Among geriatric patients with cardiometabolic conditions, PIMs are emerging as a public health priority due to vulnerability to harm from medications, polypharmacy, and comorbidities where prudent prescribing and evidence-based treatment are needed. Objective: To evaluate the prevalence of PIM use and identify factors associated with it among geriatric patients hospitalized with cardiometabolic disorders in public hospitals of Eastern Ethiopia from January 20 to July 20, 2025. Methodology: A multi-center prospective observational study was conducted across four public hospitals in Eastern Ethiopia. Patient-specific data were collected using a structured data collection tools via the Kobo Collect v2024.2.4 tool. The 2023 AGS Beers criteria and STOPP/START version 3 criteria were applied to identify potentially inappropriate medications and any omissions in prescribed medications. Bivariate and multivariate logistic regression analyses were performed to determine factors associated with the outcomes, with statistical significance set at a p-value < 0.05 and a 95% confidence interval. Results: A total of 409 patients were included in the study, with a mean age of 74.33 ± 7.29 years. The prevalence of at least one potentially inappropriate medication was 47.4% (95% CI: 42.6–52.3) according to the 2023 AGS Beers criteria and 26.4% (95% CI: 22.1 30.6) based on the STOPP version 3 criteria. Potential prescription omissions (PPOs) were identified in 44 patients (10.8%, 95% CI: 7.8–13.8). The likelihood of having a PIM according to the AGS Beers criteria was significantly higher among older patients (AOR = 15.118, 95% CI: 5.325–42.919, p < 0.001), females (AOR = 8.502, 95% CI: 3.278–22.051, p < 0.001), patients experiencing polypharmacy (AOR = 13.644, 95% CI: 4.437–41.958, p < 0.001), and those with heart failure (AOR = 9.341, 95% CI: 2.406–36.270, p = 0.001). Using the STOPP criteria, the risk of PIM was significantly associated with age (AOR = 8.622, 95% CI: 3.327–22.347, p < 0.001), female sex (AOR = 4.384, 95% CI: 1.978 10.312, p < 0.001), presence of comorbidities (AOR = 5.540, 95% CI: 2.189–14.022, p < 0.001), and diabetes mellitus (AOR = 2.795, 95% CI: 1.256–6.219, p = 0.012). Conclusion: The findings revealed a high prevalence of PIM use among geriatric patients with cardiometabolic disorders, regardless of the screening criteria applied. A notable proportion of potential prescription omissions was also observed. Key independent X | P a g e predictors of PIM use included advanced age, female sex, polypharmacy, heart failure, presence of comorbidities, and diabetes mellitus. These findings highlight the vulnerability of geriatric patients in clinical practice and emphasize the need to enhance prescriber awareness for safer medication management.