The global increase in the older adult population necessitates a comprehensive understanding of medication management to mitigate the risks associated with potentially inappropriate medications (PIMs). These medications are of particular concern due to their association with adverse drug reactions, increased hospitalization, and increased healthcare costs. This study aimed to determine the prevalence and risk factors associated with PIM use among older adult patients attending primary health care centers in Bahrain. This cross-sectional study was conducted in 2022 in 27 primary healthcare centers across Bahrain. The study included patients aged 65 years or older. A computer based simple random sample was obtained, and the Beers criteria 2023 was utilized to assess medication appropriateness. Anonymous data was retrieved from electronic medical records and analyzed via univariate, and logistic regression analyses. Among the 595 older adult patients studied, the average age was 71.7 years, with 54.5% (n = 324) being female. Most of the patients were married (70.8%, n = 421). More than half of the patients (51.3%, n = 305) received at least one PIM, with gliclazide (37%, n = 113), pantoprazole (29.8%, n = 91), and rabeprazole (27.9%, n = 85) being the most prevalent prescribed PIM. Univariate analyses revealed that PIM rates were significantly higher among females (p = 0.001) and patients with comorbidities such as diabetes mellitus (p < 0.001), essential hypertension (p < 0.001), and hyperlipidaemia (p < 0.001). Logistic regression analysis revealed that age (OR = 1.09, p < 0.001), female sex (OR = 1.645, p = 0.012), and diabetes mellitus (OR = 1.696, p = 0.029) were significant predictors of PIM use. This study highlights the significant burden of PIM use among older adult patients in Bahrain, with more than half of the participants receiving at least one PIM. These findings underscore the urgent need for targeted interventions, particularly among female patients, those with chronic conditions such as diabetes mellitus, and patients taking five or more medications. These insights contribute to the broader understanding of geriatric pharmacotherapy and offer a foundation for policy development aimed at optimizing medication safety in aging populations.