The FORTA (Fit fOR The Aged) List 2015: Update of a Validated Clinical Tool for Improved Pharmacotherapy in the Elderly

Excerpt

Multimorbidity and polypharmacy represent a major problem for older people. Patients aged 65 years and older may take five or more drugs in 44 % (male) and 57 % (female) of cases and ten or more drugs in 12 % of cases [1]. Critical amendment of medication schemes is important to avoid both under- and overtreatment; listing approaches are considered to be potentially useful aids, given the limited paid consultation time in general practices. Most listing approaches (e.g. Beers in the USA, PRISCUS in Germany [2, 3]) are explicit—thus not requiring intricate knowledge about patients—and mainly state what not to give to older patients. Their interventional clinical impact is still controversial; they are mostly used for epidemiological studies on the prevalence of potentially inappropriate medications [4]. A list of alternative medications has recently been published to replace high-risk medications [5], which, however, does not cover wide therapeutic areas and does not provide cross-therapeutic prioritization guidance. The FORTA (Fit fOR The Aged) List 2012 was published in Drugs & Aging [6] as the first drug list combining positive and negative labeling of drugs chronically prescribed to older patients. Its labels range from A (indispensable) to B (beneficial), C (questionable) and D (avoid), depending on the state of evidence for safety, efficacy and age appropriateness [7]. The START criteria [8], as the main competing listing approach positively stating what to do in given clinical situations, describe packages of treatments and may lead to additive prescriptions if several criteria are met; in contrast, FORTA allows for cross-therapeutic prioritization. Meanwhile, the clinical utility, implementability and teachability of the FORTA List 2012 have been validated in controlled clinical trials [9, 10], demonstrating a profound effect on medication quality (reduction of over- and undertreatment) and adverse drug reactions. As its application aims to improve both over- and undertreatment, the FORTA score has been developed as the sum of individual errors in both segments; typically, negatively labeled drugs (C/D) may represent overtreatment, while beneficial drugs (A/B) are often omitted (undertreatment). …