The problems of using NSAIDs in the elderly

It has been estimated that, in the United Kingdom, at least, women over the age of 65 years are more likely than not to have taken a nonsteroidal anti-inflammatory drug (NSAID). It is against this enormous use that reports of toxicity must be balanced. There has been a tendency during the past decade to deprecate the use of NSAIDs, especially in the elderly. Yet, despite the well-known problems associated with these agents in older patients, such as reduced glomerular filtration rate, this group of drugs is tolerated surprisingly well. Nevertheless, some NSAIDs do have a greater propensity to cause gastrointestinal bleeding, especially in older female patients. Ketoprofen, metabolized by the liver, may have advantages over other NSAIDs in the elderly. This paper reviews the problems associated with the use of NSAIDs in older patients. In general, NSAIDs have proved to be an advance in the management of rheumatic diseases in the elderly, displacing the far more toxic aspirin.