For non-frail elderly patients with osteoarthritis (OA), there are good reasons to prefer acetaminophen or even opioids over NSAIDs. This is the outcome of an extensive literature review by authors from Duquesne University, the University of Pittsburgh, and the Pittsburgh VA system.
Looking specifically for studies that examined the use of analgesics for osteoarthritis among patients over the age of 65,the authors went beyond searching in databases of medical literature to scrutinize the citations for further studies.
It is now "well-established," they say, that the risks for gastrointestinal toxicity and kidney damage as a result of NSAID use are increased among elderly individuals, while the evidence of increased risk for liver damage from acetaminophen in older patients is "limited." For treatment of severe osteoarthritis pain, they add, except for elderly patients with a history of opioid misuse the advantages of pain control may outweigh the risks.
Acetaminophen should be the "mainstay" of OA treatment in this age group, they conclude, while NSAIDs are best considered for short-term use only.
The article "Adverse Effects of Analgesics Commonly Used by Older Adults With Osteoarthritis: Focus on Non-Opioid and Opioid Analgesics" appears in the American Journal of Geriatric Pharmacotherapy.