Objective: To determine the prevalence of polypharmacy and potentially inappropriate medication use (IMU) among older adults presenting to the emergency depart-ment (ED), identify demographic and clinical factors associated with IMU, and compare the performance of three validated screening tools in this setting.
Material and Methods: This prospective, single-center observational study was conducted in the ED of a tertiary training and research hospital over a three-month period beginning on March 1, 2022. Consecutive patients aged 65 years and older who were triaged as green or yellow, used at least one systemic medication, and had a complete, verifiable medication history were enrolled. Each medication list was independently screened using the 2019 American Geriatrics Society Beers Criteria, the STOPP version 2 criteria, and the Turkish TIME-to-STOP/TIME-to-START criteria. Agreement between the tools was quantified using Cohen’s kappa. Associations with IMU and hospitalization were examined using the chi-square or Fisher’s exact test, the independent-samples t-test or Mann–Whitney U test, and multivariable logistic regression.
Results: A total of 203 patients were included (mean age, 76.5±7.4 years). Polypharmacy, defined as the use of five or more medications, was present in 94.1% of pa-tients, with a mean of seven medications per patient. At least one potentially inappropriate medication was identified in 100 patients (49.3%) by at least one tool. The STOPP criteria identified the highest proportion (69/203, 34.0%), followed by the Beers Criteria (54/203, 26.6%) and the TIME criteria (31/203, 15.3%); only one patient (0.5%) was identified by all three tools. Agreement was low to moderate between Beers and STOPP (κ=0.316) and poor between Beers and TIME (κ=−0.182) and between STOPP and TIME (κ=−0.039). Proton pump inhibitors, antipsychotics, and non-steroidal anti-inflammatory drugs were the medication classes most frequently flagged. Coronary artery disease was associated with IMU in the unadjusted analysis (p=0.03). The frequency of IMU did not differ between hospitalized and discharged patients (53.5% versus 58.0%; p=0.544), and IMU positivity by any tool was not independently associated with hospitalization after multivariable adjustment.
Conclusion: Polypharmacy and potentially inappropriate medication use are highly prevalent among older adults presenting to the ED, but the three screening tools identified substantially different patient groups. The tools should be regarded as complementary rather than interchangeable, and structured medication review re-mains necessary alongside any single instrument.
Keywords: Aged, Deprescribing, Emergency service, Hospital, Inappropriate prescribing, Polypharmacy, Potentially inappropriate medication list
, Orhan Delice2 
