UPDATE OF A VALIDATED CLINICAL TOOL FOR IMPROVEMENT OF DRUG TREATMENT IN THE ELDERLY

Many studies have revealed that elderly people are frequently the victims of inappropriate drug treatment. The major problem is that for most of the drugs there is no evidence regarding efficacy and safety in the elderly. This dilemma is intensified by the high incidence of multimorbidity and therefore polypharmacy in this group of patients. To increase the appropriateness of pharmacotherapy in the elderly we have developed a clinical aid called the FORTA List. FORTA was originally created by Wehling and validated and expanded by experts in a Delphi consensus procedure. Later on, we evaluated FORTA’s usefulness in a pilot clinical study as well as in a controlled prospective trial. Both of them confirmed that FORTA significantly ameliorates the quality of pharmacotherapy and reduces the incidence of adverse drug reactions. As an evidence-based tool the FORTA List needs frequent updates as the field of geriatric pharmacology advances rapidly. Therefore, we conducted a new Delphi survey to update this useful clinical tool. This Delphi consensus procedure involved 21 experts who evaluated the proposal of 4 initiators. The new FORTA List now contains 48 (21.3%) additional items as compared to its previous version and 3 new indications (nausea and vomiting, hypothyroidism, obstipation) were added to the list resulting in 29 indications in total. Besides, all medications used to treat dementia associated depression (n=3) and anticancer medications (n=27) received a less positive classification than before. All in all, the updated list now covers more illnesses and contains more medications used to treat elderly patients.