Analgesic drug use in elderly persons: A population-based study in Southern Italy

Abstract

IntroductionAnalgesics such as non-steroidal anti-inflammatory drugs (NSAIDs), weak and strong opioids are commonly used among elderly persons. The aim of this study was to describe the demographic and clinical characteristics of elderly analgesic users and to measure the frequency of analgesic use, including the frequency of potentially inappropriate analgesic use.MethodsThe Arianna database was used to carry out this study. This database contains prescription data with associated indication of use for 1,076,486 inhabitants registered with their general practitioners (GPs) in the Caserta Local Health Unit (Caserta district, Campania region in Italy). A cohort of persons aged ≥65 years old with >1 year of database history having at least one analgesic drug (NSAIDs, strong or weak opioids) between 2010 and 2014 were identified. The date of the first analgesic prescription in the study period was considered the index date (ID).ResultsFrom a source population of 1,076,486 persons, 116,486 elderly persons were identified. Of these, 94,820 elderly persons received at least one analgesic drug: 36.6% were incident NSAID users (N = 36,629), while 13.2% were incident weak opioid users (N = 12,485) and 8.1% were incident strong opioid users (N = 7,658). In terms of inappropriate analgesic use, 9.2% (N = 10,763) of all elderly users were prescribed ketorolac/indomethacin inappropriately, since these drugs should not be prescribed to elderly persons. Furthermore, at least half all elderly persons with chronic kidney disease or congestive heart failure were prescribed NSAIDs, while these drugs should be avoided.ConclusionAnalgesics are commonly used inappropriately among elderly persons, suggesting that prescribing practice in the catchment area may yet be improved.

Analgesic purchases among older adults – a population-based study

“…It has been discussed that NSAID use does not adhere to clinical guidelines (e.g. long-term or pro re nata use despite contraindications) in older adults [ 10 – 13 ], among whom NSAIDs have been suggested to comprise a major cause of drug-related morbidity [ 14 ]. NSAID-related peptic ulcers, renal and cardiovascular adverse effects, and increased mortality have been reported [ 14 , 15 ].…”

“…Studies regarding analgesic administration among community-dwelling older adults are scarce [ 10 , 13 , 18 , 19 ]. It remains unclear how large a proportion of older adults actually use analgesics and whether the medication consists of NSAIDs or paracetamol, or of neuropathic drugs or opioids [ 11 , 20 ].…”

Protective Effect of Curcumin against Sodium Salicylate-Induced Oxidative Kidney Damage, Nuclear Factor-Kappa Dysregulation, and Apoptotic Consequences in Rats

“…Additionally, most hepatic cytochrome P450 mRNA expressions are reduced with aging [ 64 , 65 ]. Simultaneously, elderly persons extensively use analgesics such as non-steroidal anti-inflammatory drugs and herbal supplements such as CUR [ 66 , 67 ]. Thus, more caution should be taken with the co-use of SS with CUR in elderly persons, and further studies on this point are highly warranted.…”

An Italian Expert Consensus on the Use of Opioids for the Management of Chronic Non-Oncological Pain in Clinical Practice: Focus on Buprenorphine.

“…Furthermore, at least half of all elderly people with chronic kidney disease or congestive heart failure were prescribed NSAIDs, though these drugs should be avoided. 20 The 3-step approach of the WHO analgesic ladder for oncological pain is appropriate also for non-oncological chronic pain (Statement 3).…”