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  • We analyzed data on age, sex, and drug use in 1 346 709 elderly persons aged ≥ 65 years registered in the Swedish Prescribed Drug Register (SPDR) in July to September 2008. The SPDR contains information about all prescription drugs dispensed at Swedish pharmacies to the entire Swedish population (about 9 million inhabitants) [22]. Via record linkage to the Swedish Social Services Register, we also retrieved information about type of housing (i.e. home dwelling / institution). Since 2007, all Swedish municipalities report individual-based information of institutional care to this register [23]. Almost all institutional care in Sweden is organized and granted by the municipalities. We calculated a 1-day point prevalence for drug use on the arbitrarily chosen date of September 30, 2008. The method for the calculations has been described in detail elsewhere [24]. Briefly, since prescription drugs are dispensed for at most 3 months in Sweden, we used information about when the prescription was filled, the amount of drugs dispensed and prescribed dosage, from the preceding 3 months to calculate the 1-day point prevalence. If the same drug was dispensed more than once during the 3 month period, it was calculated as one drug. The Anatomical Therapeutic Chemical (ATC) classification system was used for classification of drugs, as recommended by the Word Health Organization [25]. APD usage, defined as use of any dopaminergic anti-Parkinson drug in ATC-class N04B (i.e. Dopa and dopa derivatives (ATC-code N04BA), adamantane derivatives (N04BB), dopamine agonists (N04BC), monoamine oxidase B inhibitors (N04BD) and other dopaminergic agents (N04BX)) was used as a proxy for PD [26]. The following drug classes that may increase the risk of falls in old people (i.e. FRIDs) were analyzed: opioids (ATC-code N02A), antipsychotics (N05A (N05AN excluded)), anxiolytics (N05B), hypnotics and sedatives (N05C), antidepressants (N06A), vasodilators used in cardiac diseases (C01D), antihypertensives (C02), diuretics (C03), beta-blocking agents (C07), calcium channel blockers (C08), agents acting on the renin-angiotensin system (C09), alpha-adrenoreceptor antagonists (G04CA), dopaminergic anti-parkinson drugs (N04B) [27] and anticholinergic drugs [19]. We used a list of anticholinergic drugs published by the Swedish National Board of Health and Welfare: anticholinergic drugs for functional gastrointestinal disorders (A03AB, A03BA, A03BB), anticholinergic antiemetics (A04AD), antiarrhythmic s (C01BA), drugs for urinary frequency and incontinence (G04BD), opioids in combination with antispasmodics (N02AG), anticholinergic anti-parkinson drugs (N04A), some antipsychotics (N05AA, N05AF03, N05AH02), hydroxyzine (N05BB01), non-selective monoamine reuptake inhibitors (N06AA) and certain antihistamines (R06AA02, R06AB, R06AD, R06AX02) [27]. Hence, the use of any FRIDs in this study refer to the use of at least one drug in the above mentioned drug classes with the exception of anti-parkinson drugs in ATC class N04A and N04B, since we chose to analyze these drugs separately. The concomitant use of several FRIDs refer to the total number of used drugs in the ATC classes defined above, i.e. it can be drugs from different ATC classes or different drugs from the same ATC class. The use of specific FRIDs refer to the use of at least one drug in the respective ATC classes described above. The use of any anticholinergics refers to use of any of the anticholinergics listed above (ATC class N04A excluded). We also investigated the use of osteoporosis drugs (use of drugs in ATC classes A12AX, G03XC01, M05BA or M05BB), and polypharmacy, defined as use of ≥ 5 drugs simultaneously. The type of housing variable was defined as home-dwelling (living in own home) or institutionalized (e.g. nursing-home, sheltered accommodation) [24]. We performed both crude and multivariate logistic regression analysis in order to study whether use of APD was associated with use of FRIDS. In model 1, adjustment was made for age (continuous variable) and sex. In model 2, additional adjustment was made for type of housing. The results are presented as odds ratios with 95% confidence intervals. SPSS 22.0 for Windows (SPSS Inc., Chicago, IL) was used for the analyses. The study was approved by the regional ethical review board in Stockholm (Dnr 2009/477-31/3). Only de-identified register-based data were used.
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