Non-steroidal anti-inflammatory drug use in the elderly.
The efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of inflammation and pain of various origins is well established. Prescribing these drugs, however, remains a challenge because a great variety of gastrointestinal and cardiovascular safety issues need to be considered, particularly in older patients. Recent recommendations suggest that the prescription of non-selective NSAIDs and/or selective cyclo-oxygenase-2 inhibitors (coxibs) may be appropriate in patients with low gastrointestinal risk (no prior gastrointestinal events, no concomitant treatments with other damaging drugs). Gastroprotection is appropriate in patients with gastrointestinal risk factors and in older patients. In patients at high risk for gastrointestinal and cardiovascular events, however, NSAID or coxib prescriptions are contraindicated. Multidimensional impairment is a crucial point in evaluating the clinical outcome of older patients; thus, a comprehensive geriatric assessment is useful in predicting adverse outcomes, including morbidity and mortality.
Pilotto
Alberto
A
Department of Medical Sciences, Geriatric Unit and Research Laboratory Gerontology & Geriatrics, I.R.C.C.S. Casa Sollievo della Sofferenza, Viale Cappuccini 1, I-71013 San Giovanni Rotondo (FG), Italy. alberto.pilotto@operapadrepio.it
Sancarlo
Daniele
D
Addante
Filomena
F
Scarcelli
Carlo
C
Franceschi
Marilisa
M
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D041981:Gastrointestinal Tract / Q000187:drug effects* / Q000473:pathology; D006801:Humans; D007249:Inflammation / Q000188:drug therapy* / Q000209:etiology; D010146:Pain / Q000188:drug therapy* / Q000209:etiology
D000894:Anti-Inflammatory Agents, Non-Steroidal