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NSAID and Aspirin Use by the Elderly in General Practice

Effect on Gastrointestinal Symptoms and Therapies

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Abstract

Background

The relationship between NSAID use and gastrointestinal (GI) symptoms and their treatment in elderly patients is not well defined.

Objectives

To identify the prevalence of specific drug use in elderly outpatients and to identify the relationship between NSAID use and GI disturbances and treatments in elderly subjects treated by their general practitioner (GP).

Settingand participants

The study was carried out by 63 GPs in north-eastern Italy; 3154 elderly subjects were included in the study over a 2-week period.

Design

By using a structured interview, subjects’ medical histories and current medication were identified. In particular, the presence and use pattern (i.e. occasional, ‘acute’ or ‘chronic’) of NSAIDs and/or aspirin (acetylsalicylic acid) were recorded. In all subjects, the presence of upper GI symptoms, i.e. abdominal pain, reflux symptoms and indigestion syndrome, were noted.

Results

The prevalence of drug use was 96.4% (males 96%, females 96.7%). The most prescribed drugs were ACE inhibitors (38%), diuretics (26.7%), NSAIDs and regular-dose aspirin (24.7%), GI drugs (20.6%), and anxiolytics/hypnotics (20.3%). Of 779 subjects who had taken NSAIDs or regular-dose aspirin, 32.9% were ‘chronic’ users, 24.9% were ‘acute’ users and 42.1% occasional users. A significantly higher prevalence of upper GI symptoms was observed in elderly NSAID and low-dose aspirin users compared with non-users (24.9% vs 28% vs 16.6% respectively, p < 0.0001). GI symptoms were reported by 27.6% of ‘chronic’ NSAID users, 22.9% of ‘acute’ users and 24.7% of occasional users. A significantly higher prescription rate for any GI drug was found in NSAID users than in low-dose aspirin users and non-users (24.0% vs 19.6% vs 19.4% respectively, p = 0.007). This difference was mainly because of a higher number of upper GI drugs taken by NSAID users than by low-dose aspirin users and non-users (18.1% vs 16% vs 13.7% respectively, p = 0.004). Multivariate analysis demonstrated that female gender (odds ratio [OR] = 1.32, 95% CI = 1.16–1.44), low-dose aspirin (OR = 1.88, 95% CI = 1.33–2.65), NSAIDs and/or regular-dose aspirin (OR = 1.48, 95% CI = 1.19–1.83) and multiple therapies, i.e. taking more than four drugs per day (OR = 1.42, 95% CI = 1.14–1.77) were risk factors for GI symptoms in elderly outpatients.

Conclusion

NSAIDs and/or aspirin use was very high in this elderly outpatient population. The use of these drugs was significantly associated with a greater number of upper GI symptoms and prescriptions for GI drugs. Educational and clinical strategies need to be implemented in order to reduce the GI impact of NSAID and aspirin use in elderly people.

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Acknowledgements

The authors would like to thank the following GPs for their participation in the study: Luisa Aggio, Nunzio Arcoleo, Bruno Bertoia, Corrado Balzan, Daniela Bertolin, Maria Grazia Bolfe, Giuseppe Bond, Leopoldo Bonis, Mario Bortot, Mirko Bukovitz, Mirko Busolo, Paola Cadelli, Rosanna Caneve, Maria Teresa Cavion, Paolo Cedaro, Rosanna Celia, Federico Cesaro, Federico Costa, Roberto Costantini, Giovanni Crivelli, Gioacchino Cusmano, Rosanna Dalla Rosa, Rudi De Bastiani, Guido D’Orlando, Franco Fabbro, Alessandro Foglia, Annalisa Fragrasso, Francesca Genovese, Ezio Gionta, Laura Giuri, Giovanni Gobbo, Enrico Ioverno, Mauro Lazzaretti, Fabio Luise, Venanzio Manfreda, Davide Maran, Paolo Marano, Ermenegildo Mazzoccato, Augusto Negrini, Daniela Negroni, Lucio Pasqualetto, Pierpaolo Peruzzi, Emanuele Piazza, Alessandro Piccolo, Michele Pugliese, Vincenzo Raccanello, Lisetta Rossetto, Mirella Santarossa, Antonio Saponaro, Maurizio Sebben, Daniele Segalla, Roberta Spezzotti, Mauro Stefan, Bruna Stocchiero, Franco Tagliaferro, Fabio Tessari, Gabriele Tomat, Fabio Vianello, Ladislao Vaingerl, Sergio Vendraminetto, Omero Zago, Osvaldo Zanin, Michele Zecchin.

This study was partially supported by Roche, Milous, Italy. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

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Authors and Affiliations

  1. Geriatric Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy

    Alberto Pilotto

  2. Geriatric Unit, General Hospital, Schio (VI), Italy

    Marilisa Franceschi

  3. Gastroenterology Unit, IRCCS, Castellana Grotte (Bari), Italy

    Gioacchino Leandro

  4. Division of Gastroenterology, University of Parma, Parma, Italy

    Francesco Di Mario

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  1. Alberto Pilotto
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  2. Marilisa Franceschi
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  3. Gioacchino Leandro
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  4. Francesco Di Mario
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Correspondence to Alberto Pilotto.

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Pilotto, A., Franceschi, M., Leandro, G. et al. NSAID and Aspirin Use by the Elderly in General Practice. Drugs Aging 20, 701–710 (2003). https://doi.org/10.2165/00002512-200320090-00006

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