Prevalence of potentially inappropriate medication use and its association with hospitalization among older adults with chronic disease in the Amhara region, Ethiopia: a multicenter prospective cohort study

Background: Potentially inappropriate medications (PIMs) are common among older adults with chronic diseases and are linked to adverse outcomes, including hospitalization. Evidence on PIM prevalence and its clinical impact in Ethiopia is limited. This study assessed the prevalence of PIM use and its association with hospitalization among older adults in the Amhara Region, Ethiopia. Objectives: To determine the prevalence of PIM use and identify factors associated with PIM exposure and hospitalization in older adults with chronic diseases. Design: Multicenter prospective cohort study. Methods: Between May 1 and November 30, 2024, 1700 adults aged ⩾60 years were enrolled from five comprehensive specialized hospitals in the Amhara region. PIM use was assessed using the 2023 American Geriatrics Society Beers criteria. Sociodemographic, clinical, medication, and hospitalization data were collected via structured interviews and medical chart reviews. Multivariable logistic regression identified factors independently associated with PIM use and hospitalization. Results: = 0.023). Independent predictors of PIM use included khat chewing (AOR = 1.95), cor pulmonale (AOR = 2.28), degenerative diseases (AOR = 3.20), Charlson Comorbidity Index >4 (AOR = 4.50), prolonged chronic illness (AOR = 3.07), benzodiazepine use (AOR = 1.80), and concurrent benzodiazepine-opioid use (AOR = 4.02). Regular medication reviews were protective, reducing the risk of PIM use (AOR = 0.55). Conclusion: PIM use is highly prevalent among older adults with chronic diseases in the Amhara Region and is associated with increased hospitalization risk. Systematic medication reviews and improved prescribing practices are essential to enhance medication safety and reduce preventable hospital admissions.