A the elderly population. (4). Adverse drug events

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. NSAIDs can also 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, from changes in renal function and metabolic changes. (3).


Non-steroidal 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)


The main risk factors for ADR admissions include older age, comorbidity,
polypharmacy, and potentially inappropriate medications. (7). One study
emphasized on the need for an ADR events prediction tool to identify patients
who are high-risk (elderly population) thus target appropriate mediations in order
to prevent Adverse drug related hospital admissions. Study further emphasized
on the role of primary care doctors and pharmacists in the communities in
identifying patient at risk for ADR. (7). There are currently no validated
tools to assess the risk of ADRs in primary care.


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 that was done,
participating pharmacies involved 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 association with primary care physicians. Ns-NSAID
users from other pharmacies without associated 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 groups. Results showed that persistent ns-NSAID users from the
selected IG patients had an additional 7% possibility 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 termination
of ns-NSAIDS or to associated 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 induced gastro toxicity (2). Primary Care Physicians
should lower doses of NSAIDs to reduce adverse effects risk especially in the
group of patients with the greatest risk.