Background Despite the aging of numerous societies and future health care challenges, clinical research in the elderly is underrepresented. The aim of this review was to analyze the current practice exemplary in gerontotraumatology and to discuss potential improvements. Materials and methods A literature review was performed in 2016 based on a PubMed search for gerontotraumatologic studies published between 2005 and 2015. Trials were evaluated for methodology and ethical and age-related aspects. Results The search revealed 649 articles, 183 of which met the inclusion criteria. The age range for inclusion was heterogeneous; one-third of trials included patients <65 years and only 11% excluded very elderly. Seventy-four trials excluded patients with typical comorbidities, with 55% of these without stating scientific reasons. Frailty was assessed in 94 trials and defined as the exclusion criterion in 66 of them. Informed consent (IC) was reportedly obtained in 144 trials; descriptions of the IC process mostly remained vague. Substitute decision making was described in 19 trials; the consenting party remained unclear in 45 articles. Diagnosed dementia was a primary exclusion criterion in 31% of the trials. Seventeen trials assessed decisional capacity before inclusion, with six using specific assessments. Conclusion Many trials in gerontotraumatology exclude relevant subgroups of patients, and thus risk presenting biased estimates of the relevant treatment effects. Exclusion based on age, cognitive impairment, or other exhaustive exclusion criteria impedes specific scientific progress in the treatment of elderly patients. Meaningful trials could profit from a staged, transparent approach that fosters shared decision making. Rethinking current policies is indispensable to improve treatment and care of elderly trauma patients and to protect study participants and researchers alike.

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(>80 years), obesity (BMI>30 kg/m 2) and elevated ASA-PS scores (III and IV). Outcomes were length of stay (LOS), global postoperative complications, anastomotic leaks, readmission and reoperation rates within 30 postoperative days, and mortality. Results: 6,446 patients from 11 clinical trials were selected and divided into three groups, clustered by advanced age, BMI>30 and ASA III-IV. Highrisk patients responded differently to the application of ERAS protocol in colorectal surgery: age and ASA III-IV had a medium effect on LOS (SMD respectively of 0.464 e p<0.001-and 0.581), obesity had a small effect (SMD: 0.027). Old patients and patients with ASA III-IV showed lower levels of readmission. Old people showed a risk of a new operation greater than younger patients (OR: 1.25). There were no differences between old (OR 0.405) and obese patients (OR 1.031) and controls in anastomotic leaks, these factors show no influence on the integrity of the intestinal anastomoses. Regarding global postoperative complications: old patients had 63% more risk than younger people (OR¼1.636, p<0.001), obese subjects had a major risk of 26% (OR¼1.262), and patients with ASA score of III-IV had an OR of 0.753 of developing postoperative complications. Finally, mortality was influenced by age >80 years (OR: 3.603, p<0.001). Conclusion: High-risk patients treated according to ERAS programmes developed similar complications according to data reported by recent papers analyzing the same outcomes in high-risk patients undergoing colorectal surgery with conventional care. Older age and ASA III-IV did not influence the readmission rate. Disclosure of interest: None declared.