Supplementary Material for: FORTA Score and Negative Outcomes in Older Adults: Insights from Italian Internal Medicine Wards

Objectives: The study aimed to assess the relationship between the Fit fOR The Aged (FORTA) score – a classification system designed to evaluate medication appropriateness in older adults – and several negative outcomes, including impaired cognitive performance, functional status, adverse clinical events, and all-cause mortality at 3, 6, and 12 months after hospital discharge. Methods: This retrospective study utilized data from the ELICADHE cohort, a cluster-randomized trial conducted across 20 Italian internal medicine and geriatric wards. The study included patients aged 75 and older with complete FORTA score assessments. Demographics, medication history, and comorbidities were collected. The FORTA classification system assessed medication appropriateness. FORTA scores were calculated and FORTA score cut-offs (3 and 5) were applied. Statistical analyses included descriptive statistics, survival analysis with Cox regression, logistic regression, and negative-binomial regression using SAS 9.4 and RStudio 12.1. Ethical approval was obtained. Results: Of the 506 patients included, 171 (33.8%) were fully assessable with complete FORTA scores. The study found no significant association between higher FORTA scores and impaired cognitive performance, functional status, or mortality. Additionally, no clear relationship was observed between FORTA scores and adverse clinical events or mortality. The analysis indicated that age was a significant factor associated with mortality and adverse clinical events. Conclusion: The study did not find a significant relationship between the FORTA score and negative outcomes in older patients discharged from internal medicine and geriatric wards. Further research is needed to define specific FORTA score cut-off values and expand the criteria to improve medication assessment in this population.

研究目标：本研究旨在评估老年适宜用药评分系统（Fit fOR The Aged，简称FORTA）与老年人药物适宜性评估之间的关系，并探究该评分系统与认知功能障碍、功能状态、不良临床事件以及出院后3个月、6个月和12个月的全因死亡率之间的关联。研究方法：本研究采用回顾性研究方法，利用ELICADHE队列数据，该队列是在意大利20个内科和老年科病房进行的簇随机试验。研究纳入了年龄在75岁及以上且具有完整FORTA评分评估的病人。收集了人口统计学、用药史和合并症等信息。FORTA分类系统用于评估药物适宜性。计算FORTA评分并应用FORTA评分截断值（3和5）。统计分析包括描述性统计、Cox回归生存分析、逻辑回归和负二项回归分析，使用SAS 9.4和RStudio 12.1软件进行。已获得伦理批准。研究结果：在506名纳入的病人中，171名（占33.8%）具有完整的FORTA评分。研究未发现FORTA评分与认知功能障碍、功能状态或死亡率之间存在显著关联。此外，FORTA评分与不良临床事件或死亡率之间也未观察到明确的关系。分析表明，年龄是与死亡率和不良临床事件显著相关的因素。研究结论：本研究未发现FORTA评分与老年患者从内科和老年科病房出院后的负面结果之间存在显著关联。需要进一步研究以定义特定的FORTA评分截断值并扩展评估标准，以改善该人群的药物评估。