title: Nonsteroidal anti-inflammatory drugs (NSAIDs) in older people: prescribing patterns according to pain prevalence and adherence to clinical guidelines.
abstract: The evidence on the patterns of nonsteroidal anti-inflammatory drug (NSAID) use according to pain prevalence and clinical guidelines in older people is sparse. This cross-sectional study examined the patterns of NSAID use according to pain prevalence and concordance with clinical guideline recommendations for safe NSAID use in older people, in relation to duration of use, patterns of use, concomitant use of proton pump inhibitors (PPIs), and prevalence of specific drug interactions. Community-dwelling men (n=1696) age ≥ 70 years living in Sydney were studied. 8.2% (n=139) of participants reported regular NSAID use compared with 2.9% (n=50) reporting as-needed use. The mean treatment duration for regular NSAID use was 4.9 years, suggesting long-term rather than short-term use as recommended by the guidelines. Although guidelines recommend use of PPIs together with an NSAID, only 25.2% of regular NSAID users reported PPI use. Regular NSAID users were significantly more likely to report use of opioid analgesics (P<.0001) compared with nonregular users. In relation to pain prevalence, regular NSAID users were significantly more likely to report chronic pain (P<.0001), recent pain (P=.0001), and chronic intrusive pain (P<.0001) compared with nonregular users. The findings of this study indicate that NSAID prescribing practices do not align with clinical guidelines for safe use in older people. This difference between the guideline recommendations and what is happening in the real world should be explored further.
authors: Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia Sydney Medical School, University of Sydney, Sydney, NSW, Australia Centre for Education and Research on Ageing and Concord RG Hospital, Sydney, NSW, Australia ANZAC Research Institute, Concord Hospital, Sydney, NSW, Australia Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
authors: Danijela
authors: D
authors: Gnjidic
authors: Fiona M
authors: FM
authors: Blyth
authors: David G
authors: DG
authors: Le Couteur
authors: Robert G
authors: RG
authors: Cumming
authors: Andrew J
authors: AJ
authors: McLachlan
authors: David J
authors: DJ
authors: Handelsman
authors: Markus
authors: M
authors: Seibel
authors: Louise
authors: L
authors: Waite
authors: Vasi
authors: V
authors: Naganathan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Clinical guidelines; NSAIDs; Older people; Pain prevalence