Polypharmazie im Alter – klug entscheiden mit dem FORTA-Prinzip

Zusammenfassung

Multimorbidität und Polypharmazie sind Gefahren für ältere Patienten; die Verbesserung der Arzneimitteltherapiequalität ist wichtig und eine neue Herangehensweise – die FORTA [Fit fOR The Aged]-Liste – soll dieses Vorhaben in der klinischen Praxis unterstützen. In dieser Übersicht sollen anwendungsbezogene Details für einen erfolgreichen Gebrauch von FORTA beschrieben werden. Die Liste kategorisiert Medikamente abhängig von der Evidenz für Sicherheit, Wirksamkeit und allgemeiner Alterstauglichkeit in vier Gruppen: A (unentbehrlich), B (nützlich), C (bedenklich) und D (zu vermeiden). Als implizite Methode ist sie nur anwendbar, wenn medizinische Details zum Patienten bekannt sind. Der Prozess beginnt mit Anamnese und diagnostischem Assessment, inklusive Schweregradeinteilung der Erkrankungen. Das ist die Basis für die FORTA-unterstützte Auswahl von Medikamenten um Übertherapie (Medikament nicht nötig), Untertherapie (Zustand nicht, oder nicht ausreichend mit positiv bewerteten Medikamenten behandelt) oder Fehltherapie (Medikament indiziert, aber negatives, anstatt positiv bewertetem Medikament ausgewählt) zu vermeiden. Der Auswahl folgen sekundäre Analysen, beispielsweise bezüglich der Dosierung oder Kontraindikationen. Das Medikationsschema wird dann aufgrund der beobachteten erwünschten klinischen Effekte und Nebenwirkungen angepasst.

Abstract

Multimorbidity and polypharmacy are threats to elderly patients; improvement of medication is important and a novel listing approach – the FORTA [Fit fOR The Aged] 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 an implicit tool, it is only applicable if medical details of the patient are known. The process starts with 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 dosing or contraindications. The medication scheme is updated in reflection of wanted clinical effects (e. g. blood pressure lowering) and side effects (e. g. dizziness).

Schlüsselwörter

Polypharmazie - ältere Patienten - FORTA-Liste - implizites Instrument - Positivbewertung - Negativbewertung

Keywords

polypharmacy - elderly - FORTA-list - implicit tool - positive list - negative list

Publication History

Publication Date:
11 September 2015 (online)

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