LAUSR

To the Editor: Older people are the main recipients of medications in many regions of the world, and their population is rapidly growing. Numerous studies have shown that drug treatment is frequently inappropriate in this age group, and adverse drugs reactions pose an essential threat to them. Major reasons are the lack of evidence for most medications and the presence of multimorbidity resulting in polypharmacy.1 Unfortunately, pure negative lists (eg, the US Beers list) were clinically largely ineffective2 to address this problem; the FORTA classification (A: Absolutely; B: Beneficial; C: Careful; D: Don’t) was developed as an implicit tool representing the first positive/negative drug assessment regarding age appropriateness of drugs. Based on (generally sparse) evidence for safety and efficacy, the FORTA List was subsequently derived by a Delphi consensus procedure.3 Its current version contains 273 entries (drugs/drug groups) in 29 major indications.4 To evaluate the effectiveness of FORTA, a prospective randomized controlled study (VALFORTA trial)5 was conducted in 409 hospitalized older patients. Application of FORTA as compared with standard geriatric care significantly (P< .001) did not only improve the quality of drug treatment, but also clinical end points (eg, activities of daily living and blood pressure). In particular, FORTA significantly reduced adverse drug reactions at a number needed to treat of only 5. Both overtreatment (bad drug to be removed) and undertreatment (good drugs to be added) issues could be efficiently addressed. Hence, the FORTA List, which is based on evidence and expert knowledge, proved to be an implementable and effective tool to improve often complex medications in older people. To facilitate the use of the FORTA List in daily clinical practice a downloadable app (the FORTA App) has just been released which is bilingual (in German and English) and available at no cost (https://play.google. com/store/apps/details?id1⁄4de.sisdev.forta&hl1⁄4de). This app provides convenient search options that can facilitate the use of the FORTA List in daily clinical practice; it should help physicians [eg, general practitioners (average contact time per patient is about 8 minutes) in Germany], to swiftly review the medications of older patients and choose the appropriate medications.