The growing geriatric population in India presents significant healthcare challenges, particularly regarding the safe and effective use of medications. This prospective, observational study was conducted over 10 months at a tertiary care hospital in Coimbatore to evaluate the use of potentially inappropriate medications (PIMs) among elderly patients using the 2023 Beers Criteria and to assess their impact on quality of life (QoL). Seventy-six patients aged 65 years and above were screened. Over 47% of prescriptions contained at least one PIM, with pantoprazole being the most frequently identified. The presence of multiple comorbidities and polypharmacy were common, leading to a high incidence of drug-drug interactions, including several with major severity. QoL was measured using the FANLTC-FACIT scale and revealed moderate scores in physical, social, and functional domains but notably lower scores in emotional well-being, particularly among female patients. The findings emphasize the need for clinical vigilance, routine prescription audits, and interprofessional collaboration to minimize PIMs and optimize pharmacotherapy in elderly care. Implementation of rational medication review and withdrawal strategies, along with adherence to updated geriatric prescribing guidelines among elderly patients, could substantially enhance QoL outcomes and reduce healthcare burdens.