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Forta – Fit for the Aged

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.

296 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 30 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.

Forta Categories

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 further developed in the area of Clinical Pharmacology at the University of Heidelberg in Mannheim. The FORTA Project was 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.

Delphi Expert Consensus Validation

2012

This project involved the expert consensus validation of the labels for 190 substances/substance groups aligned to 20 indication groups. The final list contained 225 items belonging to 24 indications. The FORTA concept is outlined in a published article and the results of this procedure are compiled in the Expert Consensus Validation 2012 of the FORTA List.

2015

The first update of the FORTA List was generated in 2015; it followed the same two step-Delphi procedure that was used for its first version. This FORTA List consisted of 273 substances/substance groups aligned to 29 indications.

2018

The most recent consensus validation of the FORTA List was completed in 2018. This FORTA List now contains 296 substances/substance groups aligned to 30 indication groups.

Valforta Study

The project involved the implementation of the validated FORTA List in a controlled clinical setting. The impact of the FORTA classification system on the quality of drug prescribing/screening, and ultimately on patient outcome, was tested on a total of 409 patients in geriatric wards in two German hospitals. Nearly half of the patients received standard care and the other half received standard care plus the FORTA method.

The primary endpoint (FORTA score: a composite measure of over-, under- and mistreatment) was significantly more reduced in the intervention versus control group. Moreover, both over- and under-treatment were significantly improved in the intervention group as compared to the control group. In addition, the total number of adverse drug reactions (ADRs) was significantly reduced by FORTA and activities of daily living and renal failure improved significantly.

Here you find relevant publications including two FORTA assessments on specialized issues (OAC-FORTA, LUTS-FORTA):

Publications

Pazan F, Kather J, Wehling M. A systematic review and novel classification of listing tools to improve medication in older people. Eur J Clin Pharmacol. 2019 Jan 26. [Epub ahead of print]

Pazan F, Burkhardt H, Frohnhofen H, et al. Higher Fit-fOR-The-Aged (FORTA) Scores Comprising Medication Errors are Associated with Impaired Cognitive and Physical Function Tests in the VALFORTA Trial. Drugs Aging. 2019;36:269-277.

Pazan F, Burkhardt H, Frohnhofen H, et al. Changes in prescription patterns in older hospitalized patients: the impact of FORTA on disease-related over- and under-treatments. Eur J Clin Pharmacol. 2018 Mar;74:339-347.

Pazan F, Weiss C, Wehling M. The EURO-FORTA (Fit fOR The Aged) list: international consensus validation of a clinical tool for improved drug treatment in older people. Drugs Aging. 2018;35:61-71.

Pazan F, Wehling M. The FORTA (Fit fOR The Aged) App as a Clinical Tool to Optimize Complex Medications in Older People. J Am Med Dir Assoc. 2017 Oct 1;18:893.

Wehling M, Collins R, Gil VM, et al. Appropriateness of oral anticoagulants for the long-term treatment of atrial fibrillation in older people: results of an evidence-based review and international consensus validation process (OAC-FORTA 2016). Drugs Aging 2017; 34, 499-507.

Pazan F, Weiss C, Wehling M. The FORTA (Fit fOR The Aged) List 2015: Update of a Validated Clinical Tool for Improved Pharmacotherapy in the Elderly. Drugs Aging. 2016;33:447–449.

Wehling M. How to Use the FORTA ("Fit fOR The Aged") List to Improve Pharmacotherapy in the Elderly. Drug Res (Stuttg). 2016;66:57-62.

Wehling M, Burkhardt H, Kuhn-Thiel A, Pazan F, et al. VALFORTA: a randomised trial to validate the FORTA (Fit fOR The Aged) classification. Age Ageing. 2016;45:262-267.

Wehling M, Burkhardt H. Arzneitherapie für Ältere. Springer-Verlag, Heidelberg, 4. Auflage 2016.

Oelke M, Becher K, Castro-Diaz D, 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;44:745–755.

Michalek C, Wehling M, Schlitzer J, et al. Effects of "Fit fOR The Aged" (FORTA) on pharmacotherapy and clinical endpoints--a pilot randomized controlled study. Eur J Clin Pharmacol. 2014;70:1261-7.

Kuhn-Thiel AM, Weiß C, Wehling M. Consensus validation of the FORTA (Fit fOR The Aged) List: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly. Drugs Aging. 2014;31:131-40.

Wehling M, Ed., Drug Therapy for the Elderly. Springer, Wien 2013.

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;57:560-561.

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;133:2289-91.

Kontextspalte

FORTA App

Important notes for patients

We would like to point out that this list has been created for physicians and may serve patients for information purposes only. This list should not encourage any patient to change their medication without consulting their doctor or pharmacist.