The FORTA (Fit fOR The Aged) List 2018: Third Version of a Validated Clinical Tool for Improved Drug Treatment in Older People

Excerpt

Multimorbidity and widespread use of clinical guidelines are the main causes for highly prevalent polypharmacy in older people [1, 2]. Polypharmacy has been identified as a major risk factor for inappropriate drug treatment and adverse drug events in older patients [3‐5], and is even associated with increased mortality [6, 7]. However, the use of multiple drugs to treat serious medical conditions is often vital, but should be differentiated into appropriate/beneficial or problematic applications by the critical review of medication schemes. Several listing approaches and tools have been developed to assist prescribers in choosing the appropriate drugs for their patients. The majority of these approaches (e.g., Beers criteria [8]) are drug-oriented listing approaches (DOLA) [9] and mostly focus on what not to prescribe in older patients. Their impact on relevant clinical outcomes (e.g., mortality or hospitalization) is still unclear [10], with the majority of randomized clinical trials failing to demonstrate improvement of clinical endpoints [9]. In contrast, a few listing approaches (e.g., the FORTA [Fit fOR The Aged] List) are patient-in-focus listing approaches (PILA); they recommend both what to do and what not to do, requiring intricate medical knowledge about patients. For PILA, the majority of randomized trials have been clinically successful [9]. …