Improving recruitment of older people to research through good practice

Abstract

There is widespread evidence both of the exclusion of older people from clinical research, and of under-recruitment to clinical trials. This review and opinion piece provides practical advice to assist researchers both to adopt realistic, achievable recruitment rates and to increase the number of older people taking part in research. It analyses 14 consecutive recently published trials, providing the number needed to be screened to recruit one older participant (around 3:1), numbers excluded (up to 49%), drop out rates (5-37%) and whether the planned power was achieved. The value of planning and logistics are outlined, and approaches to optimising recruitment in hospital, primary care and care home settings are discussed, together with the challenges of involving older adults with mental incapacity and those from minority groups in research. The increasingly important task of engaging older members of the public and older patients in research is also discussed. Increasing the participation of older people in research will improve the generalisability of research findings and inform best practice in the clinical management of the growing older population.

Recruiting Older People at Nutritional Risk for Clinical Trials: What Have We Learned?

“…Older adults may lack understanding of the study protocols, have lower levels of education and be unwilling to make a time commitment [32]. Furthermore, some older persons find research studies intrusive through excessive interviews or collection of biological samples [8].…”

A programme of research to set priorities and reduce uncertainties for the prevention and treatment of skin disease

“…Advanced age, physical frailty, the presence of comorbidities and uncertainty about the future were also identified as reasons why some people may be reluctant to become involved in research. Age-related factors are recognised as a significant barrier to recruitment into trials 701,722 yet, in the proposed trial, the population pool from which recruits will be drawn will be largely > 70 years of age. Exclusion criteria related to comorbid conditions and previous malignancies may therefore need to be modified in the protocol if older and more frail patients are to be included in the research and for the trial results to be externally valid.…”

Ethical and legal aspects of anaesthesia for the elderly

“…In addition, the patient must not appear to object to take part, and the welfare of the patient must always be placed above the importance of the research and confirmed by an appointed third party [54][55][56][57]. Although this process can appear so resource-and time-intensive as to inhibit the conduct of research involving the elderly, this has been found not necessarily to be the case, provided provision is made for the inherent difficulties anticipated [58,59].…”