Which class should be avoided chronically in older adults due to GI bleed risk, unless a protective agent is used?

• A. Acetaminophen
• B. Non-COX-2 NSAIDs
• C. Opioids
• D. Antacids

Answer: (B)

Non-selective (non-COX-2) NSAIDs are the class to avoid chronically in older adults because they significantly raise the risk of gastrointestinal bleeding and ulcers. They inhibit COX-1, which reduces the protective prostaglandins in the stomach lining, making GI injury more likely—an issue that becomes more important with age and in people with comorbidities. The Beers Criteria recommends not using these drugs long-term in older patients unless a protective agent is also used, such as a proton pump inhibitor or misoprostol, to help guard the GI tract.

Other options don’t carry the same chronic GI bleed risk profile. Acetaminophen is gentler on the GI tract and often preferred for chronic pain in the elderly, while opioids and antacids don’t address the specific GI bleeding risk associated with NSAIDs.