Optimising medication use among older people remains a key challenge in an ageing society. A recent analysis based on the German National Cohort (NAKO) systematically examined the incidence of over-prescribing, under-prescribing and inappropriate prescribing, as well as factors that might be associated with these, among 54,296 participants.
The focus was on how frequently potentially unsuitable medicines are used in older people and which patient groups are at particular risk. The FORTA list (“Fit fOR The Aged”), a clinical assessment system for drug therapy in older people, served as a guide. It classifies medicines into four categories: A for particularly suitable medicines, B for suitable medicines with restrictions, C for active substances to be regarded as critical, and D for preparations to be avoided where possible.
The analysis, led by researchers at the German Cancer Research Centre (DKFZ), shows that potentially unsuitable medicines, as well as under- and over-prescription, are not uncommon in older people, and that, in addition to the number of medicines taken, comorbidities, functional limitations and other care-related factors can also play a significant role.
According to the analysis carried out by NAKO researchers, more than a quarter of older people are prescribed medicines that are considered potentially unsuitable for them. The risk of being prescribed too many medicines was particularly high among people with epilepsy and depression. In contrast, there was a greater risk of under-prescription for Parkinson’s disease, osteoporosis, COPD and atrial fibrillation.
“The results make it clear that, for older patients, it is not only important to avoid potentially unsuitable medicines, but also to regularly review whether a treatment is still indicated, adequate or perhaps too extensive. Our analysis therefore provides important insights into where closer scrutiny is needed in the care of older people,” concludes Miriam Degen, lead author and researcher in the Department of Clinical Epidemiology and Cancer Screening at the DKFZ in Heidelberg.
Originalpublication
Degen M, Haug U, Scholle OHF, et al. Factors associated with potentially inappropriate medication use, medication underuse and overuse in older adults in the German National Cohort. J Intern Med. 2026:joim.70097. http://doi.org/10.1111/joim.70097
Further information
FORTA-List
The FORTA classification system stands for ‘Fit fOR The Aged’ and divides medicines into four categories:
A = ‘essential’ B = ‘useful’ C = ‘questionable benefit’ D = ‘avoid’
FORTA-List