title: Effects of "Fit fOR The Aged" (FORTA) on pharmacotherapy and clinical endpoints--a pilot randomized controlled study.
abstract: OBJECTIVE
  The feasibility of applying the Fit fOR The Aged (FORTA) list, a drug classification combining positive and negative labeling of drugs, should be studied in geriatric patients and medication quality and clinical endpoints measured. FORTA labels range from A (indispensable), B (beneficial), C (questionable) to D (avoid).
  
  
  METHODS
  A prospective randomized controlled pilot trial was performed in hospitalized geriatric patients in whom the FORTA instrument or standard care was applied. Patients were randomly admitted to an intervention and a control ward. Changes of FORTA label distributions between admission and discharge, over- and under-prescription rates, clinical endpoints including the number of falls during the hospitalization, and Barthel Index (BI) at admission and discharge were measured.
  
  
  RESULTS
  Polypharmacy persisted in both groups. At discharge, a higher rate of A drugs was prescribed in the intervention group (58 patients, median age 84 years) vs. standard care (56 patients, median age 83 years, p < 0.02), and both over- and under-prescriptions were significantly lower in the FORTA than in the control group (p < 0.03). Two (3.4%) intervention, but 12 (21.4%) control, patients fell at least once (p < 0.001). The fall rate per 1,000 patient years was 1.5 ± 8.3 in the intervention and 10.6 ± 25.4 in the control group (p < 0.004).
  
  
  CONCLUSIONS
  This pilot study shows that the application of the FORTA list is feasible in geriatric patients. In this small study, the medication quality improved in the intervention group, but polypharmacy persisted in both groups. The fall rate was significantly lower in the intervention group. These encouraging results must be interpreted carefully.
authors.affiliation: Geriatric Clinic and Center for Geriatric Medicine, Knappschafts-Krankenhaus, Kliniken Essen-Mitte, Teaching Hospital of the University Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany.
authors.forename: Carina
authors.initials: C
authors.lastname: Michalek
authors.forename: Martin
authors.initials: M
authors.lastname: Wehling
authors.forename: Jeanina
authors.initials: J
authors.lastname: Schlitzer
authors.forename: Helmut
authors.initials: H
authors.lastname: Frohnhofen
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D006760:Hospitalization; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D010351:Patient Discharge; D010865:Pilot Projects; D019338:Polypharmacy; D010818:Practice Patterns, Physicians' / Q000592:standards; D055553:Prescription Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies
chemical_list: D055553:Prescription Drugs