Odds ratios with 95% confidence intervals for use of fall-risk inducing drugs in persons using APDs^a compared to persons not using APD^a.

<p>Odds ratios with 95% confidence intervals for use of fall-risk inducing drugs in persons using APDs<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0161246#t003fn001" target="_blank">^a</a> compared to persons not using APD<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0161246#t003fn001" target="_blank">^a</a>.</p

Basic characteristics of the study population according to APD^a user status.

<p>Basic characteristics of the study population according to APD<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0161246#t001fn001" target="_blank">^a</a> user status.</p

The composition of polypharmacy: A register-based study of Swedes aged 75 years and older

<div><p>Background</p><p>Polypharmacy is common among older adults. However, little is known about the composition of polypharmacy: which are the most frequently used drugs, and how much do these drugs contribute to the overall prevalence of polypharmacy.</p><p>Methods</p><p>A total of 822,619 Swedes aged ≥75 years was identified from the Total Population Register. Through record-linkage with the Swedish Prescribed Drug Register and the Social Services Register we could analyze concurrent drug use in the entire population (both individuals living in the community and institution) on the 31 December 2013.</p><p>Results</p><p>The prevalence of polypharmacy (≥5 drugs) was 45%. The most frequently used drugs were cardiovascular drugs, analgesics, and psychotropics. By excluding the ten most frequently used drug classes or compounds, the prevalence of polypharmacy was reduced by 69% and 51% respectively. The majority of the users of either one of the 10 most frequently used drugs concurrently used at least 4 other drug classes (66%-85%).</p><p>Conclusion</p><p>Almost half of the individuals aged ≥75 years are exposed to polypharmacy in Sweden. A handful of drugs make a large contribution to the overall prevalence of polypharmacy and the majority of drugs prescribed to persons aged ≥75 years are used in combination with other drugs. This highlights the high use of drugs, and the need to consider other concurrent drug treatments when prescribing for older adults.</p></div

The composition of polypharmacy: A register-based study of Swedes aged 75 years and older - Fig 2

<p>Prevalence and concomitant use of other drugs for A: drug classes (3rd level ATC) and B. drug compounds (5th level ATC), in the total study population (n = 822,619) Sweden 2013.</p

Characteristics of the population stratified by polypharmacy, excessive polypharmacy and living arrangement.

<p>Aged ≥75 years Sweden, 2013.</p

Prevalence of polypharmacy and number of drugs used (mean and median) after exclusion of the top 1 to 10 most frequently used drugs among individuals aged ≥75 years, Sweden 2013.

<p>Prevalence of polypharmacy and number of drugs used (mean and median) after exclusion of the top 1 to 10 most frequently used drugs among individuals aged ≥75 years, Sweden 2013.</p

Illustration of the method used to estimate the medication list.

<p>A medication list was estimated at the transition to multi-dose drug dispensing (MDD) as well as at up to 12 measure dates before and after this date, respectively, with three month intervals. For drugs purchased in whole packages (prescribed via ordinary prescriptions or MDD) at any time during the three month period preceding the measure date (light grey bar), the duration of treatment with the drug was estimated according to (i) the date of filling the prescription, (ii) the amount of drug dispensed, and (iii) the prescribed daily dose, or, if not available, the mean daily dose in the study population. If the duration of the drug covered the measure date, the drug was included in the medication list, i.e. drug a, but not drug b. Concerning drugs prescribed via the MDD system and dispensed into units bags, all drugs purchased within the time frame of the dark grey bar, but not the dotted one, were included in the medication list. *All drugs prescribed vid ordinary prescription and about 50% of drugs prescribed via the MDD system <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0067088#pone.0067088-Nordling1" target="_blank">[12]</a> are delivered in whole packages.</p

Flowchart of the study population.

<p>The study population was extracted from individuals residing in the Region Västra Götaland at any time during the study period (1^st July 2005–31^st December 2010).</p

Longitudinal results for 30,922 individuals at three month intervals before and after the transition to multi-dose drug dispensing (index date).

<p>(A) The mean number of unique drugs and substances (primary y-axis), the cumulative number of unique ICD-10-diagnoses, and the number of healthcare contacts within each three month period (secondary y-axis). (B) The proportion of the patients without a change in the number of drugs at a specific measure date compared with the previous one. (C) The proportion of the patients who had potentially harmful drug treatment according to indicators of prescribing quality. The individuals were censored when they returned to ordinary prescriptions and after death. The number of individuals included at each specific measure date is presented below the figures.</p

ATC substances that increased by more than 1000 orders at the index date in individuals alive three months after the index date still filling multi-dose drug dispensed prescriptions.

<p>ATC substances that increased by more than 1000 orders at the index date in individuals alive three months after the index date still filling multi-dose drug dispensed prescriptions.</p