Skip to main content
SpringerLink
Log in

Higher Fit-fOR-The-Aged (FORTA) Scores Comprising Medication Errors are Associated with Impaired Cognitive and Physical Function Tests in the VALFORTA Trial

  • Original Research Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Background

The Fit fOR The Aged (FORTA) list, a drug classification combining positive and negative labelling of drugs, has been clinically (VALFORTA-trial) validated to improve medication quality and clinical endpoints.

Objective

The objective of this study was to determine the association of medication quality with functional abilities tested in cognitive and physical function tests.

Patients and Methods

Data from the prospective, randomized controlled VALFORTA trial on 409 geriatric (mean age 81.53 years) in-hospital patients were tested for associations between the FORTA score (sum of over- and under-treatment errors) on admission and cognitive and physical function tests. Univariate and multivariate linear correlations corrected for age, sex, number of medications, number of chronic conditions, and body mass index as well as comparisons between high and low FORTA-score (cut-off 3) patients were performed.

Results

The FORTA score was significantly correlated with Instrumental Activities of Daily Living (p < 0.0001), the Tinetti test (p < 0.002), Essen Questionnaire on Age and Sleepiness (p < 0.0001), Mini-Mental State Examination (p < 0.0001), and handgrip strength (p < 0.04) in the univariate analysis, and with Instrumental Activities of Daily Living (p < 0.003), the Tinetti test (p < 0.003), and the Essen Questionnaire on Age and Sleepiness (p < 0.0001) in the multivariate analysis. Effect size was weak for Instrumental Activities of Daily Living (R-squared = 0.12) and the Tinetti test (R-squared = 0.03) and medium for the Essen Questionnaire on Age and Sleepiness (R-squared = 0.22). Significant differences between patients with high and low FORTA scores were found for Instrumental Activities of Daily Living, the Tinetti test, mini-nutritional assessments, Mini-Mental State Examination, Essen Questionnaire on Age and Sleepiness, and the Geriatric Depression Scale. All significant tests revealed that higher FORTA scores (lower medication quality) were associated with less favorable test outcomes.

Conclusions

The FORTA score is associated with relevant aspects of comprehensive geriatric assessment, underlining the importance of medication quality for the functional and cognitive well-being of older patients.

Trial Registration Number

DRKS00000531.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13:57–65.

    Article  PubMed  Google Scholar 

  2. Barnett K, Mercer SW, Norbury M, et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380:37–43.

    Article  PubMed  Google Scholar 

  3. McNamara KP, Breken BD, Alzubaidi HAT, et al. Health professional perspectives on the management of multimorbidity and polypharmacy for older patients in Australia. Age Ageing. 2017;46:291–9.

    Google Scholar 

  4. Molokhia M, Majeed A. Current and future perspectives on the management of polypharmacy. BMC Fam Pract. 2017;18:70.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hamilton HJ, Gallagher PF, O’Mahony D. Inappropriate prescribing and adverse drug events in older people. BMC Geriatr. 2009;9:5.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Wauters M, Elseviers M, Vaes B, et al. Too many, too few, or too unsafe? Impact of inappropriate prescribing on mortality, and hospitalization in a cohort of community-dwelling oldest old. Br J Clin Pharmacol. 2016;82:1382–92.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cadogan CA, Ryan C, Hughes CM. Appropriate polypharmacy and medicine safety: when many is not too many. Drug Saf. 2016;39:109–16.

    Article  PubMed  Google Scholar 

  8. Hall CD, Karpen SC, Odle B, et al. Development and evaluation of the medication-based index of physical function (MedIP). Age Ageing. 2017;46:761–6.

    Article  PubMed  Google Scholar 

  9. Morley JE. Inappropriate drug prescribing and polypharmacy are major causes of poor outcomes in long-term care. J Am Med Dir Assoc. 2014;15:780–2.

    Article  PubMed  Google Scholar 

  10. Wehling M. Drug therapy for the elderly. Vienna: Springer; 2013.

    Book  Google Scholar 

  11. Wehling M. Guideline-driven polypharmacy in elderly, multimorbid patients is basically flawed: there are almost no guidelines for these patients. J Am Geriatr Soc. 2011;59:376–7.

    Article  PubMed  Google Scholar 

  12. Crome P, Lally F, Cherubini A, et al. Exclusion of older people from clinical trials: professional views from nine European countries participating in the PREDICT study. Drugs Aging. 2011;28:667–77.

    Article  PubMed  Google Scholar 

  13. Watts G. Why the exclusion of older people from clinical research must stop. BMJ. 2012;344:e3445.

    Article  PubMed  Google Scholar 

  14. Clegg A, Relton C, Young J, et al. Improving recruitment of older people to clinical trials: use of the cohort multiple randomised controlled trial design. Age Ageing. 2015;44:547–50.

    Article  PubMed  Google Scholar 

  15. Shenoy P, Harugeri A. Elderly patients’ participation in clinical trials. Perspect Clin Res. 2015;6:184–9.

    Article  PubMed  PubMed Central  Google Scholar 

  16. The American Geriatrics Society 2015 Beers Criteria Update Expert Panel, American Geriatrics Society. Updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;2015(63):2227–46.

    Article  Google Scholar 

  17. Gallagher P, Ryan C, Byrne S, et al. STOPP (screening tool of older person’s prescriptions) and START (screening tool to alert doctors to right treatment): consensus validation. Int J Clin Pharmacol Ther. 2008;46:72–83.

    Article  CAS  PubMed  Google Scholar 

  18. 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.

    Article  CAS  PubMed  Google Scholar 

  19. 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;57:560–1.

    Article  PubMed  Google Scholar 

  20. Kuhn-Thiel AM, Weiss C, Wehling M, The FORTA Authors/Expert Panel Members. 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.

    Article  CAS  PubMed  Google Scholar 

  21. 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;33:447–9.

    Article  PubMed  Google Scholar 

  22. Pazan F, Weiss C, Wehling M, et al. 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.

    Article  PubMed  Google Scholar 

  23. 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;74:339–47.

    Article  PubMed  Google Scholar 

  24. Wehling M, Burkhardt H, Kuhn-Thiel A, et al. VALFORTA: a randomised trial to validate the FORTA (Fit fOR The Aged) classification. Age Ageing. 2016;45:262–7.

    Article  PubMed  Google Scholar 

  25. Michalek C, Wehling M, Schlitzer J, Frohnhofen H. 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.

    Article  CAS  PubMed  Google Scholar 

  26. Wickop B, Härterich S, Sommer C, et al. Potentially inappropriate medication use in multimorbid elderly inpatients: differences between the FORTA, PRISCUS and STOPP ratings. Drugs Real World Outcomes. 2016;3:317–25.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gamé X, Peyronnet B, Cornu JN. Fesoterodine: pharmacological properties and clinical implications. Eur J Pharmacol. 2018;15(833):155–7.

    Article  CAS  Google Scholar 

  28. Parker SG, McCue P, Phelps K, et al. What is comprehensive geriatric assessment (CGA)? An umbrella review. Age Ageing. 2018;47:149–55.

    Article  CAS  PubMed  Google Scholar 

  29. Frohnhofen H, Fulda S, Frohnhofen K, et al. Validation of the Essener Questionnaire of Age and Sleepiness in the elderly using pupillometry. Adv Exp Med Biol. 2013;755:125–32.

    Article  CAS  PubMed  Google Scholar 

  30. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Lawrence Erlbaum Associates; 1988. p. 79–80.

    Google Scholar 

  31. Altman DG. Relation between two continuous variables. In: Altman DG, editor. Practical statistics for medical research. London: Chapman and Hall/CRC; 1990. p. 277–324.

    Google Scholar 

  32. Wu YH, Wang CJ, Hung CH, et al. Association between using medications with anticholinergic properties and short-term cognitive decline among older men: a retrospective cohort study in Taiwan. Geriatr Gerontol Int. 2017;17(Suppl 1):57–64.

    Article  PubMed  Google Scholar 

  33. Langeard A, Pothier K, Morello R, et al. Polypharmacy cut-off for gait and cognitive impairments. Front Pharmacol. 2016;7:296.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Wehling M. Older people, a plethora of drugs, and drug list approaches: useful, efficacious, or a waste of time? J Am Med Dir Assoc. 2016;1(17):1073–5.

    Article  Google Scholar 

  35. Van der Cammen TJ, Rajkumar C, Onder G, et al. Drug cessation in complex older adults: time for action. Age Ageing. 2014;43:20–5.

    Article  PubMed  Google Scholar 

  36. Landi F, Russo A, Liperoti R, et al. Impact of inappropriate drug use on physical performance among a frail elderly population living in the community. Eur J Clin Pharmacol. 2007;63:791–9.

    Article  CAS  PubMed  Google Scholar 

  37. Koyama A, Steinman M, Ensrud K, et al. Long-term cognitive and functional effects of potentially inappropriate medications in older women. J Gerontol A Biol Sci Med Sci. 2014;69:423–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical Faculty Mannheim, Institute for Clinical Pharmacology, Ruprecht-Karls-University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Farhad Pazan & Martin Wehling

  2. IV. Medical Department, Geriatrics, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Heinrich Burkhardt

  3. Department of Medicine, Faculty of Health, University Witten-Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany

    Helmut Frohnhofen

  4. Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Christel Weiss

  5. Department of Cardiology and Angiology, Agaplesion Markus Hospital, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Germany

    Christina Throm

  6. MEDIAN Klinik Sonnenwende, Sonnenwendstr. 86, 67098, Bad Dürkheim, Germany

    Alexandra Kuhn-Thiel

Authors
  1. Farhad Pazan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heinrich Burkhardt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Helmut Frohnhofen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christel Weiss
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christina Throm
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alexandra Kuhn-Thiel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Martin Wehling
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin Wehling.

Ethics declarations

Funding

The study was funded by the DFG, German Research Foundation (WE 1184/15-1 to Martin Wehling and Heinrich Burkhardt, FR2997/2-1 to Helmut Frohnhofen).

Conflict of Interest

Martin Wehling was employed by AstraZeneca R&D, Mölndal, as the director of discovery medicine (translational medicine) from 2003 to 2006, while on sabbatical leave from his professorship at the University of Heidelberg. Since returning to this position in January 2007, he has received lecturing and consulting fees from Sanofi-Aventis, Bayer, Berlin-Chemie, Boehringer-Ingelheim, Aspen, Novartis, Takeda, Roche, Pfizer, Bristol-Myers, Daichii-Sankyo, Lilly, Otsuka, Novo-Nordisk, Shire, and LEO Pharma. Helmut Frohnhofen received lecturing and consulting fees from Amgen. Farhad Pazan, Heinrich Burkhardt, Christina Throm, Alexandra Kuhn-Thiel, and Christel Weiss have no conflicts of interest that are directly relevant to the contents of this study.

Ethical Approval

The study was approved by the Ethics Committee of the Medical Faculty Mannheim, Heidelberg University and the Ethics Committee of the University of Witten-Herdecke.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 175 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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 36, 269–277 (2019). https://doi.org/10.1007/s40266-018-0626-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-018-0626-3

Search

Navigation