Why Doctors Aren't Prescribing Aspirin for Older Adults

Aspirin is a low-cost pain-relief medication. People also take it to lower the risk of stroke and heart attacks. But research indicates it is only effective for those who have had a previous heart attack or stroke. Older adults who take aspirin daily have a higher risk of bruising and a small risk of bleeding into the stomach or the brain. Plus, aspirin can interact negatively with other medications, including over-the-counter options.

According to the National Institutes of Health, nearly 29 million people take daily aspirin unnecessarily and without a doctor’s recommendation. While it may be effective for issues such as minor headaches, it can cause significant problems for some individuals. Studies in recent years also show that taking daily aspirin increases the risk of major hemorrhage in older adults.

Two major clinical trials found that low-dose aspirin did not prevent subsequent heart attacks or strokes. The first study, the ARRIVE trial, included men over the age of 55 and women over the age of 60 who had elevated risks of heart issues. The second study, the ASPREE trial, studied aspirin use in adults over 70, and Black or Hispanic people over the age of 65 with no known cardiovascular disease (CVD). Researchers found that a daily dosage of aspirin had no preventative effect.

Studies suggest that aspirin may reduce the risk of bowel cancers, as well as esophageal, stomach, pancreatic, liver, and gallbladder cancers. However, additional studies show that aspirin can cause internal bleeding, gastritis, and liver problems in older adults and those with gastric ulcers. Neither European nor American guidelines recommend aspirin as a cancer preventative until more supporting information is available.

The medical community once considered diabetes to be “cardiovascular disease equivalent” and routinely prescribed daily aspirin to all patients with diabetes. Due to recent studies, doctors now prescribe aspirin only to those patients with a high risk of CVD. This primarily includes those under the age of 50 who have at least one major risk factor and do not have an increased risk of internal bleeding.

Many medical communities once believed that daily aspirin could reduce the risk of stroke. A study in 2015 of more than 14,000 Japanese patients between the ages of 60 and 85 found that aspirin did not prevent strokes. The study also concluded that adults over the age of 70, those who smoked, and those who had diabetes were at higher risk of stroke regardless of daily aspirin dosages.

A second part of the ASPREE analysis showed that daily doses of aspirin did not reduce the risk of cognitive decline or dementia in older adults with no history of CVD. Researchers followed the subjects of the study for five years and determined that daily aspirin doses did not prolong their lives, prevent physical disability, or lower their risk of dementia.

Doctors sometimes prescribe blood thinners and aspirin for patients with atrial fibrillation. Anticoagulants prevent blood clots, while aspirin prevents blood platelets from joining together to form clots. Taking aspirin while also taking prescription blood thinners can be especially risky for older adults. Combining the two can lead to hemorrhages in the stomach. Always speak with a physician before combining medications.

Researchers recommend that only a select group of high-risk adults take aspirin daily. Additionally, these adults must not be at risk of bleeding. Studies show that the risks of healthy adults taking aspirin outweigh the benefits. The latest recommendations include a 10-year CVD risk estimation for high-risk adults between 40 and 75 years of age before starting any pharmacological treatment, including aspirin.

Blood vessels become more fragile and leak as people get older. Doctors warn older adults against taking aspirin regularly due to this issue. Bruises, resulting from broken capillaries near the skin’s surface, are common for older individuals and can be a problem. Because aspirin prevents blood platelets from clustering together to control bleeding, taking it can mean bleeding takes longer to stop and creates larger bruises.