FORTA, "Fit for the aged", is a drug classification system designed as a clinical tool to help in monitoring and optimizing the drug therapy and care management of older patients*. 273 items consisting of the most frequently used substances/substance classes for the long-term drug therapy of older patients (with exceptions to this rule) aligned to 29 diagnoses/indication areas have been assigned positive and negative labels ranging from A - B - C - D according to the state of evidence as to risk/benefits and age-appropriateness**.
The categories are defined as follows:
|Class A||= This drug has proved indispensable; there are clear-cut benefits in terms of efficacy/safety ratio in elderly patients for a given indication|
|Class B||= This drug has proven or obvious efficacy in the elderly, but does also have limitations in the extent of effect or additional safety concerns|
|Class C||= This drug has questionable efficacy/safety profiles in the elderly, should be avoided or omitted in the presence of too many drugs; lack of benefits or emerging side effects; review/find alternatives|
|Class D||= This drug should be avoided in the elderly; omit first and review/find alternatives|
This innovative approach aimed at improving and facilitating the screening, prescribing and monitoring of drug therapy for older patients, is currently being developed in the area of Clinical Pharmacology in cooperation with the Division of Geriatric Medicine, Medical Division IV (Geriatric Center) together comprising the Center for Geriatric Pharmacology, at the University of Heidelberg in Mannheim. The FORTA Project is a two-part development program funded by the German Research Foundation, Grant Nr. WE 1184/15-1. This approach represents another advance in worldwide research efforts aimed at adding a new dimension to already-existing classification systems and negative listings of potentially inappropriate medications for the elderly.
Wehling M. Drug therapy in the elderly: too much or too little, what to do? A new assessment system: fit for the aged FORTA. Dtsch Med Wochenschr 2008;133(44):2289-91.
Wehling M. Multimorbidity and polypharmacy: how to reduce the harmful drug load and yet add needed drugs in the elderly? Proposal of a new drug classification: fit for the aged. J Am Geriatr Soc 2009;57(3):560-561.
Wehling M, Burkhardt H. Arzneitherapie für Ältere. Springer-Verlag, Heidelberg, 3. Auflage 2013. (German-language)
Wehling M, Ed., Drug Therapy for the Elderly. Springer, Wien 2013.
Co-Authors Heinrich Burkhardt, MD; University Hospital Mannheim, Heidelberg University, Germany
Lutz Frölich, MD; Central Institute of Mental Health, Mannheim, Germany
Stefan Schwarz, MD; Central Institute of Mental Health, Mannheim, Germany
Ulrich Wedding, MD; University Hospital, Jena, German
Wehling et al., VALFORTA: a randomised trial to validate the FORTA (Fit fOR The Aged) classification. Age Ageing. 2016;45(2):262-267.
As the first detailed comparative assessment of individual drugs by the FORTA system (FORTA-PLUS), 16 urological drugs frequently used to treat lower urinary tract symptoms (LUTS) were chosen and rated by 5 international experts. A two-stage Delphi process was implemented after a systematic review of literature on clinical trials in older patients treated by those drugs. In total, only 25 papers with such data could be identified, underpinning the lack of evidence in the field which is typical for this age group. As result, no drug was rated at the FORTA-A-level (indispensable). Only three were assigned to FORTA B (beneficial): dutasteride, fesoterodine and finasteride. The majority was rated FORTA C (questionable): darifenacin, mirabegron, extended release oxybutynin, silodosin, solifenacin, tadalafil, tamsulosin, tolterodine and trospium. FORTA D (avoid) was assigned to alfuzosin, doxazosin, immediate release oxybutynin, propiverine and terazosin. The results demonstrate that ratings for drugs from the same group, e.g. antimuscarinergics, may differ considerably: for this group ratings span from B (B-eneficial) through C (C-areful) to D (Don't) underlining the need for careful choice and patient monitoring to avoid harmful side effects.
Further details in Oelke et al. Appropriateness of oral drugs for long-term treatment of lower urinary tract symptoms in older persons: results of a systematic literature review and international consensus validation process (LUTS-FORTA 2014). Age Ageing. 2015;44(5):745–755.
An update of the FORTA List which followed the same two step-Delphi procedure as stated for its first version was performed in 2015. You can find the FORTA List 2015 and the FORTA App (available on Google Play) at the top right corner of this website.
Further details in Pazan et al. The FORTA (Fit fOR The Aged) List 2015: Update of a Validated Clinical Tool for Improved Pharmacotherapy in the Elderly. Drugs Aging. 2016;33(6):447–449.