Taking 10 and more drugs is unpredictable and may cause more harm than good, given that up to 100,000 medication-related deaths in the United States annually.
An early attempt to improve drug safety in the aged population was the establishment of criteria for drugs to avoid by Beers in 1997.
The evidence for the effectiveness of the Beers list is not compelling.. There should also be a positive labelling of drugs that are indispensable in elderly people as data on morbidity, mortality, and safety are available or emerging for this particular group. There is increasing clinical evidence for beneficial action of, for example, antihypertensive drugs (e.g., Hypertension in the Very Elderly Trial) in elderly people.
Drugs should be labelled taking into consideration their usefulness for elderly people (Table 1) This classification would be an extension of the Beers approach into the positive listing of valuable drugs. This seems necessary as overtreatment and undertreatment are both typical problems of the aged population. Undertreatment, for example, relates to the poor control of arterial hypertension elderly people and may leave more than half of the patients un- or undertreated.
The FORTA classification for antihypertensive drugs as an example is as follows: diuretics B, betablockers B, renin-angiotensin-system blockers A, long acting dihydropyridine calcium channel blockers (CCB) A, CCBs, verapamil type D, spironolactone C, alphablockers C, clonidine D, minoxidil D.
The typical use of the scheme would address general practitioners struggling with polypharmacy. They would then synthesize the recommendations into a rank order of drugs that they could use to cut the list short.