Abstract
Background: Multimorbidity and polypharmacy are threats to elderly patients; improvement of medication
is important and a novel listing approach (the FORTA list) should support this in
clinical practice. Here we aim to describe procedural details of successful application
of FORTA. FORTA labels range from A (indispensable), B (beneficial), C (questionable)
to D (avoid), depending on evidence for safety, efficacy and overall age-appropriateness.
As implicit tool it is only applicable if medical details of the patient are known;
the drug selection process and secondary assessments are compiled into a manual for
successful, embedded use of FORTA.
Discussion: A flow chart is developed for the complex process of medication in the elderly starting
from history taking and diagnostic assessment including disease grading. This is the
base for FORTA-assisted selection of drugs to avoid overtreatment (drug not necessary),
undertreatment (condition not or not sufficiently treated by positively labeled drugs)
or mistreatment (drugs indicated, but negatively rather than positively labeled drug
chosen). Selection is followed by secondary analyses, e. g. regarding contraindications
(e. g. allergies), former drug responses, interactions, route of application, duration
and dosing (e. g. renal adaptation). This may lead to iterative process optimization.
The medication scheme is updated in reflection of clinical effects (e. g. blood pressure)
and side effects (e. g. dizziness).
Conclusion: The FORTA approach as an implicit tool should be embedded into the diagnostic and
therapeutic workup of elderly patients and can give pivotal hints for the choice of
medications; however it should not be seen as an isolated instrument.
Key words
polypharmacy - elderly - FORTA-list - implicit tool - positive list - negative list
