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Background and Importance The growing complexity of healthcare underscores the need for patient-centred medication reviews to ensure safe drug use. Pharmacist interventions in older adults (≥65 years) have been shown to significantly reduce hospital readmissions and emergency visits. To deliver effective and timely medication reviews, it is essential to evaluate patient-specific risk factors and establish strategies that prioritise high-risk patients for pharmacist-led interventions.Aim and Objectives This study aimed to evaluate associations between patient-specific risk factors and drug-related problems (DRPs), with the goal of developing criteria to identify high-risk patients for targeted pharmacist interventions.Material and Methods This retrospective single-centre study included patients aged ≥65 years who were hospitalised at Asan Medical Centre in March 2025. Patient-specific risk factors and DRPs were assessed, and their associations were analysed to identify predictors and selection criteria for high-risk patients.Results Among 2,574 patients, 313 (12.2%) had DRPs and 2,261 (87.8%) did not. A total of 578 pharmacist interventions were recorded, most commonly related to potentially inappropriate medications (19.0%), laboratory-based dose adjustments (12.0%), and therapeutic duplication (12.0%). Significant associations were observed between DRPs and most patient-specific risk factors, excluding selected laboratory abnormalities. Independent predictors of DRPs included: Clinical Frailty Scale (CFS ≥5, OR 6.203, 95% CI 4.562–8.436, p<0.001), impaired renal function (eGFR <30;, OR 1.944, 95% CI 1.229–3.075, p=0.005), polypharmacy (≥5 drugs;, OR 2.409, 95% CI 1.500–3.865, p<0.001; ≥10 drugs;, OR 9.162, 95% CI 5.604–14.978, p<0.001), ≥2 opioids (OR 1.853, 95% CI 1.072–3.203, p=0.027), ≥1 TDM drug (OR 1.751, 95% CI 1.061–2.891, p=0.028), and therapeutic duplication (OR 1.641, 95% CI 1.158–2.326, p=0.005).Conclusion and Relevance Patient-specific risk factors, including polypharmacy, frailty, impaired renal function, opioid use, TDM drugs, and therapeutic duplication, were significantly associated with increased risk of DRPs. These findings highlight the importance of incorporating risk factor-based criteria into patient selection strategies for pharmacist-led interventions. Further multicentre, prospective studies are warranted to strengthen the evidence base and refine prioritisation frameworks.Conflict of Interest No conflict of interest