Defining inappropriate practices in prescribing for elderly people

Table 3: Inappropriate practices in prescribing NSAIDs and other analgesics for elderly people
Practice	Mean clinical significance rating	Risk to patient	Alternative therapy	% of panel members who agreed with alternative
Long-term prescription of NSAIDs to treat osteoarthritis for patients with a history of peptic ulcer	3.78	May cause recurrence of peptic ulcer	Nondrug therapy or acetaminophen or NSAID with gastroprotective agent	97
Prescription of phenylbutazone to treat chronic osteoarthritis	3.69	May cause bone-marrow depression	Acetaminophen or intermittent dosage of an NSAID of another class	100
Prescription of ASA to treat pain for patients already receiving warfarin	3.61	May cause increased bleeding	Acetaminophen	91
Long-term prescription of meperidine or pentazocine for pain	3.58	May cause falls, fractures, confusion, dependency and withdrawal	Stepped approach involving nondrug therapy, then acetaminophen, then codeine, morphine or hydromorphone if needed	91
Long-term prescription of NSAIDs to treat osteoarthritis for patients with chronic renal failure	3.56	May worsen renal failure, may cause salt and water retention	Nondrug therapy, then acetaminophen	97
Prescription of NSAIDs to treat osteoarthritis for patients already receiving warfarin	3.56	May cause increased bleeding	Nondrug therapy or acetaminophen or NSAID with gastroprotective agent	81
Long-term prescription of NSAIDs to treat osteoarthritis for patients with a history of heart failure	3.38	May cause salt and water retention, may worsen heart failure	Nondrug therapy or acetaminophen or close monitoring of heart failure	97
Long-term prescription of piroxicam, ketorolac or mefenamic acid to treat pain	3.35	Greater risk of upper gastrointestinal-tract bleeding than that associated with other NSAIDs	Nondrug therapy or acetaminophen; switch to a different NSAID or to codeine	81
Long-term prescription of NSAIDs for patients with a history of hypertension	3.34	May cause salt and water retention and exacerbation of hypertension	Nondrug therapy, acetaminophen or ASA, or close monitoring of blood pressure	91
Long-term prescription of indomethacin to treat gout	3.32	May cause gastropathy, neurologic side effects and salt and water retention	Allopurinol or intermittent dosage of NSAID as needed	50
Long-term prescription of NSAIDs to treat osteoarthritis	3.22	May cause gastropathy, bleeding and salt and water retention	Acetaminophen	100

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