Institute for Experimental and Clinical Pharmacology and Toxicology, Department of Clinical Pharmacology, Center for Geriatric Pharmacology, Medical Faculty Mannheim, University of Heidelberg, Maybachstr. 14, 68169, Mannheim, Germany.
Drugs Aging. 2014 Feb;31(2):131-40. doi: 10.1007/s40266-013-0146-0.
Multimorbidity and polypharmacy represent a major problem for elderly patients; improvement of medication schemes is important and listing approaches (e.g. Beers list) are considered to be potentially useful.
The aim of this study was to perform expert consensus validation of the FORTA (Fit fOR The Aged) List, a drug classification combining positive and negative labelling of drugs chronically prescribed to elderly patients.
A two-round Delphi procedure was conducted involving 20 experts, 17 geriatric internists and 3 geriatric psychiatrists from Germany and Austria, evaluating the labels assigned to 190 substances or substance groups. These labels ranged from A (indispensable), B (beneficial), C (questionable) to D (avoid), depending on the state of evidence for safety, efficacy and overall age-appropriateness. The experts were also requested to suggest additional substances and indication areas for assessment and possible inclusion in the FORTA List. A weighted (corrected) consensus coefficient was generated for each substance to reflect (1) agreement with the original label, and (2) distribution among raters' labels.
The overall consensus for all items and raters was 92% (corrected). For 54/190 items (28.4%), a unanimous response was achieved as to the original author-based FORTA label choice. Twenty-four substances (12.6%) fell short of the consensus cutoff and were re-evaluated in a second round. This yielded confirmation of 171/190, or 90%, of the original author-based FORTA labels. A total of 35 new substances were also accepted for the FORTA List. Drugs used for dementia and dementia syndromes provoked particular response heterogeneity.
The FORTA List now reflects a wider consensus among experts, increasing its validity for clinical use. It represents a tool to improve the quality of drug prescription in older patients by identifying both inappropriate and omitted drugs, and thus overtreatment and undertreatment. The validation of FORTA's impact on clinical endpoints has yielded promising preliminary results, to be corroborated in ongoing larger trials.
多种疾病和多种药物治疗在老年患者中是一个主要问题；改善药物治疗方案很重要，列出方法（如 Beers 清单）被认为是有潜在作用的。
本研究旨在对 FORTA（适合老年人）清单进行专家共识验证，该清单是一种将慢性开给老年患者的药物进行阳性和阴性标签分类的药物分类方法。
采用两轮 Delphi 程序，涉及来自德国和奥地利的 20 名专家，包括 17 名老年内科医生和 3 名老年精神科医生，评估了 190 种物质或物质组的标签。这些标签从 A（必不可少）、B（有益）、C（可疑）到 D（避免）不等，取决于安全性、疗效和总体适合年龄的证据状态。还要求专家建议其他需要评估和可能纳入 FORTA 清单的物质和适应症领域。为每个物质生成加权（校正）共识系数，以反映（1）与原始标签的一致性，以及（2）评估者标签的分布。
所有项目和评估者的总体共识为 92%（校正）。对于 54/190 项（28.4%），对于原始作者基于 FORTA 标签选择，达成了一致的回应。有 24 种物质（12.6%）未达到共识截止值，在第二轮中重新进行了评估。这证实了 171/190，或 90%，的原始作者基于 FORTA 标签。还为 FORTA 清单接受了总共 35 种新物质。用于痴呆和痴呆综合征的药物引起了特别的反应异质性。
FORTA 清单现在反映了专家之间更广泛的共识，提高了其在临床应用中的有效性。它代表了一种通过识别不适当和遗漏的药物来改善老年患者药物处方质量的工具，从而避免过度治疗和治疗不足。验证 FORTA 对临床终点的影响取得了有希望的初步结果，需要在正在进行的更大规模试验中加以证实。
