The 5Ts Framework serves as a valuable organizing model for the best practice recommendations we have gathered for improving inclusion across the lifespan. To see recommendations for each “T” select Target population, Team, Time, Tips to Accommodate, or Tools. Or to narrow the list of recommendations to those most relevant to your study, use the filters to select your “Data collection method,” “Study design,” “Study setting”, current study “Activity,” or “Person.”
Recommendations
Displaying 9 Recommendations
| Avoid exclusion criteria that disproportionately affect older adults. Exclusion criteria that disproportionately affect older adults: co-occurring conditions (comorbidity), functional limitations, hearing and vision impairment, cognitive impairment, inability to give informed consent, recent hospitalization/health event, living in a nursing home or assisted living facility, serious illness, or limited life-expectancy. Discretionary exclusions such as "deemed inappropriate," "unlikely to complete study protocol," or "at risk for adverse events" also exclude older adults. Do not use age as a proxy for frailty or risk for adverse events. References: |
 Target Population
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| Know the demographics (average age, gender and race) and prevalence of age-related limitatons and co-occurring chronic diseases among adults with the condition being studied. Adults ≥65 years old make up about 15% of the US Population (>55 million people) and this number is expected to increase over the next 20 years. Most disease populations and healthcare populations include an even higher percentage of older adults. Start by estimating the percentage of older adults in the target population (who should findings generalize to), then set recruitment goals by age and track inclusion during enrollment. Useful Link: https://www.census.gov/topics/population/older-aging.html Reference: https://pubmed.ncbi.nlm.nih.gov/19093934/ |
Target Population
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| Know the range of preferred languages of your target population, and ensure materials and communication are inclusive of preferred languages. Example: The PREVENTABLE Study brochure is in English and Spanish (linked below). Useful Link: https://preventabletrial.org/English%20and%20Spanish%20Brochure.pdf |
Target Population
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| Build culturally competent and inclusive research teams that include members of the target community. Approaches to research inclusion of underrepresented populations designed for younger populations may not adequately address the added barriers that older adults face. These barriers may be at the individual or structural level. Lessons learned in the clinical care of older adults could be used in research. The American Geriatrics Society has several resources that may be helpful. References: |
 Team
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| Engage experts in aging research, and assemble study teams with experience interacting with older participants. Aging research experts include geriatricians (clinicians trained in caring for older adults) and gerontologists (sociologists, psychologists, and other scientists focused on issues related to aging). Also consider experts from the many fields that provide interdisciplinary healthcare or conduct research in older populations such as nursing, physical therapy, occupational therapy, pharmacy, social work, and audiology. Useful Link: https://www.peppercenter.org/ |
Team
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| Involve participants, their family, their caregivers, their health care providers, and/or their community advocates as active members of the team. Older adults often look to their family, caregivers, community leaders, and healthcare providers for advice about participating in research. In many cases older adults may depend on others for transportation, scheduling appointments, or help adhering to study protocols. Rather than seeing these people a "gatekeepers," researchers should identify how these "team members" may help support participation in the study. Useful Link: https://clic-ctsa.org/education/community-engaged-research-cenr-diverse-older-adults |
Team
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| Limit time requirements by reducing the number of study measures, using brief study measures, and avoiding low-priority study measures. (Limit time requirements) Avoid collecting data "just in case" or for unplanned future research. Often measures that are collected in research are never analyzed or used. Prioritize measurement plans based on outcomes that are important to older adults. Pilot test data collection in older participants to obtain a more accurate estimate of time burden. Select "short form" measures when possible or use item response theory to limit the number of questions within an instrument. Examples include the Patient-Reported Outcomes Measurement Information System (PROMIS). Useful Link: https://www.healthmeasures.net/search-view-measures |
 Time
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| Electronic enrollment tracking system with capability to provide periodic enrollment reports by age. (Tools for recruitment and enrollment) Table 1 from Mody et al Recruitment and Retention of Older Adults in Aging Research (linked below) provides strategies for tracking accrual and loss to follow-up. Reference: https://pubmed.ncbi.nlm.nih.gov/19093934/ |
 Tools
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| Select appropriate tools that measure outcomes important to older adults (Measurement tools specific to older adults, Choose tools that measure function, physical performance, and patient-reported outcomes as appropriate). (Cognitive limitations) Examples: Great examples of measures can be found from the Duke Pepper Center, the Geriatric Research Instrument Library (GRIL), and from the CTSA Inclusion of older adults in research workgroup. Useful Links:
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Tools
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