Underrepresentation of older adults in clinical research continues to be an important topic. In this news post, we review a few recent publications with relevance to inclusion across the lifespan. Additionally, we wanted to highlight a few ways the 5Ts could be used to address the challenges described in these papers.
An interesting systematic review of barriers and facilitators to inclusion of older adults in long-term care (LTC) and acute care geriatrics settings was recently published by Nguyen and colleagues in BMC Geriatrics. Authors used a mixed methods approach that included an environmental scan, a systematic literature review, and qualitative synthesis. Using this approach, they identified people (e.g., research teams, long-term care staff, caregivers), research stages (e.g., study planning, recruitment, data collection), and themes (ethics, communication/trust, collaboration). The people and themes differed for the LTC and acute care settings. For example, the clinical staff are key people in LTC research, and themes around human resources such as staff turnover impact research processes. Whereas, family care partners had a much bigger role in acute care settings. When thinking about a Team, researchers should think more broadly about who is important for the team and how that may differ by research setting.
Academic research institutions can also play a role in improving inclusion. In a recent publication in the Journal of Clinical and Translational Science, Eckstrom and colleagues describe results of an innovative pilot project designed to improve inclusion of older adults at the Institutional Review Board (IRB) submission stage. The team reviewed the concordance between older adults in proposed study populations in IRB submissions with older adults in the disease condition being studied. In situations where there was a mismatch between the protocol age and the disease demographics, they requested a meeting with the PI to assess the rationale for the study age and find ways to support the research team. Several studies expanded the age range in their IRB protocol. In addition to expanding the age criteria, research investigators could also look to the 5Ts for recommendations to support inclusion of older adults at the protocol development stage.
We were also excited to read the results of a large community-partner engaged approach and literature review to identify and refine a list of recommendations to guide research that is relevant to older adults conducted in the UK by the National Institute for Health and Care Research (NIHR) Innovations in Clinical Trials Design and Delivery for the Underserved (INCLUDE). The multidisciplinary team identified 14 recommendations and organized these by the socio-ecologic model’s levels of individual, interpersonal, organizational, community, and policy. These recommendations are well-aligned with the 5Ts recommendations highlighting the key issues that need to be addressed to improve inclusion of older adults in research.