A lot of older patients take NSAIDS
chronically. There are a lot of adverse effects associated with chronic NSAID
use including the risk of acute
renal failure, stroke/myocardial infarction, peptic ulcer disease, as well as worsening
of other chronic diseases including heart failure, hypertension, and can
interact with a number of drugs (warfarin, corticosteroids) ultimately increasing
hospitalizations amongst the elderly population. (4). Adverse drug events are
more likely to affect geriatric patients due to physiological changes occurring
with aging, due to changes in renal function and metabolic changes. (3).


The main risk factors for ADR-related
admissions are advanced age, polypharmacy, comorbidity, and potentially
inappropriate medications. (7). One study emphasized on the need for an adverse
drug related events prediction tool in elderly patients since they are more
vulnerable for ADR hospitalizations, and further emphasized on the role of
primary care doctors and pharmacists in the communities (7).


Currently, there are no validated tools
to assess the risk of ADRs in primary care. There is a clear need to
investigate the utility of tools to identify high-risk patients to target
appropriate interventions toward prevention of ADR-related hospital admissions.


anti-inflammatory drugs are a common class of analgesic typically used
chronically for pain such as musculoskeletal pain including osteoarthritis. It
is commonly used in the elderly population.

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Approximately 40% of people
over 65 years of age fill one or more prescriptions of NSAIDS each year not
including the over the counter NSAIDs. (5)


According to a systematic review and meta-analysis that was
performed through a computerized search of main databases, between 1988 to
2015, addressing adverse drug reaction-induced hospital admissions in
patients over 60 years of age, NSAIDS was the most common medication
induced adverse effects leading to hospitalizations ranging for 2.3 to 33.3%. (6)           


According to a prospective cohort study
done, participating pharmacies were called the intervention group (IG) and received
feedback on drug dispensing in non selective -NSAID users of ?60?years of age
at risk for UGI damage and were instructed to select patients to improve
ns-NSAID prescribing, in collaboration with primary care physicians. Ns-NSAID
users from other pharmacies without concomitant Gastro-protective agents GPA
use were followed in parallel as a control group (CG). Changes in the UGI risk
of ns-NSAID users between baseline and follow-up measurement, assessed either
by the addition of GPAs or the cessation of ns-NSAIDs, were compared between
the two study arms. Results showed that persistent ns-NSAID users from the
selected IG patients had an additional 7% likelihood of reduced UGI risk at
follow-up (odds ratio 0.93, 95% confidence interval 0.89–0.97) compared with CG
patients. In the IG, 91% of selected IG patients at UGI risk from ns-NSAIDs at baseline
were no longer at increased risk at follow-up because of cessation of ns-NSAIDS
or to concomitant GPA use. (10)


There is approximately one per 1000
persons per year in the general population with an incidence of hospitalization
for complicated peptic ulcer disease among non-users of anti-inflammatory drugs
compared to four and five events of hospitalization amongst na-NSAIDs users
with higher incidence with higher dose of any NSAIDs (1)


It is important to understand
the negative complications of NSAIDS which includes increased mortality,
morbidity and increased health care cost. Providers should discuss potential
adverse effects of NSAIDS to patients and also review medication list as some
patients may be taking multiple NSAIDS without understanding the adverse
effects of NSAIDS and recognize patients at risk for developing adverse events.

It is one of the most preventable causes for hospital admissions in the
elderly.  Patients taking NSAIDS are more
likely to be hospitalized versus those not taking NSAIDS. Patients with a history of peptic ulcer disease could benefit the most
from a reduction in NSAID gastrotoxicity (2). Primary Care Physicians should lower
doses of NSAIDs to reduce adverse effects risk especially in the group of
patients with the greatest risk.


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