Background <p>Falls in older adults might increase due to polypharmacy.</p> Aim <p>This study aimed to explore the association between preadmission medications and history of falls in older inpatients.</p> Method <p>This observational study of inpatients aged ≥ 65&#xa0;years was conducted over 4&#xa0;years at Ballina Hospital, Australia. The Medication Regimen Complexity Index (MRCI), Drug Burden Index (DBI), and Anticholinergic Effect on Cognition (AEC) scores were calculated for preadmission medications. Polypharmacy and falls questionnaires were administered to identify falls in the past 6&#xa0;months and aptitude toward medication use.</p> Results <p>Overall, 194 participants with a mean age of 80.2 (SD 8.0) years were included. The mean daily number of regular medications was 7.8 (SD 3.9) and the mean MRCI score was 22 (SD 12.6). Among the participants, 107 (55%) reported falls in the past 6&#xa0;months and 47 (24%) reported ≥ 2 falls. Age and hearing impairment were positively associated with falls (<i>p</i> = 0.007 and <i>p</i> = 0.003, respectively). History of falls was positively associated with a MRCI score of ≥ 20 (<i>p</i> = 0.018), an AEC score of ≥ 2 (<i>p</i> = 0.010) and a DBI score of ≥ 1 after adjustment for age (<i>p</i> = 0.041). Forgetting medications was associated with falls (<i>p</i> = 0.043). Antihypertensive use did not increase falls risk.</p> Conclusion <p>Implementing a decisive approach to simplify complex medication regimens, along with patient-focused medication management strategies, may help reduce the risk of falls in older adults. Sedatives and anticholinergic medications increase the risk of falls and should be avoided whenever possible.</p>