Background: Increasing life expectancy in the community has led to a growing prevalence of changes and disorders such as arthritis, which has been accompanied by increasing use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).However, its utilization pattern may differ among rural and urban elderly. Aim of the study: was to assess the utilization pattern of Non-Steroidal Anti-Inflammatory Drugs among community-dwelling elderly living in Urban versus Rural areas. Subjects & methods: Research design: A cross sectional descriptive comparative research design was used. Setting: Community- dwelling elderly's own homes in two governorates. One is rural from El-Behera Governorate, and the other is urban from Alexandria Governorate. Subjects: A convenience sample of 640 Community-Dwelling elderly with three hundred and twenty from each of the above mentioned settings. Tools of data collection: I) Mini Mental State Examination (MMSE) Scale II) Community-Dwelling Elders' NSAIDs Utilization Pattern Structured Interview Schedule composed of five parts to collect data about socio-demographic characteristics, NSAIDs utilization pattern, sources of NSAIDs information, presence of contraindications to use NSAIDs and Knowledge of the elderly about NSAIDs. Results: NSAIDs users were 580 of the study subjects from both rural and urban areas. Rural participants are significantly more likely to have higher rate relative to urban participants to use of NSAIDs as an analgesic (p<0.001), use of drug as Over-The-Counter (OTC) (p<0.001). And they have experience of NDAIDs' side effect (p<0.001). The majority of both rural and urban study subjects reported that they don't receive any instructions from the nurse about NSAIDs, with no statistically difference. Conclusion: NSAIDs utilization was significantly higher among rural than urban residence, whether it was prescribed or non-prescribed (OTC).Rural participants were significantly more likely to had poor level of knowledge about NSAIDs relative to urban participants. Recommendations: Community health and gerontological nurses have the responsibility for training the nurses who works in different rural and urban health care settings about NSAIDs.