Recruitment of older people to research

Concern has been expressed for a long while about the lack of older people included in clinical trials. However, the inclusion of older people in research in general is a subject worthy of attention. There are many reasons why it is sometimes difficult to recruit people over 70 into research. Some of these are self-evident, e.g. the presence of co-morbidities leading to travel difficulties, reluctance to take on something that may be onerous, cultural divisions, language barriers, research skills capacity, a greater risk of ill health, and the reluctance of family members to support an elderly relative in a research project.

In a clinical trial context, under-representation of older subjects across a range of conditions has implications for our knowledge about efficacy and safety especially. Also, older people are more likely to trigger the exclusion criteria for trials, even though eventually a successful treatment will often be prescribed “across the board”, i.e. to people who were excluded from trials. Similar biases can creep into other types of research too, and these may affect the generalizability of the findings to the elderly population as a whole. This is a particular concern with conditions that are very common such as dementia, where there have been repeated calls to rethink our approach to the make-up of research populations.

Age and Ageing has published a modest number of papers on this topic over the years. Some of them are listed below. They include the patient’s perspective and also methodological issues. It is clear that some of the barriers are very similar to those reported in recruitment in younger age groups. On a positive note, there is a strong indication that older people can understand the science of the research they are participating in, and many enjoy the processes involved in being a research participant. These papers are a helpful context for the BGS’s evolving Research Strategy, which will include the need to address the recruitment issue.

1. Improving recruitment of older people to research through good practice. Marion McMurdo. May 2011
2. Planning trials in older patients with stroke: data from the International Stroke Trial, Maciej Czionkowska. March 2011
3. Optimising recruitment into a study of physical activity in older people: a randomised controlled trial of different approaches,Tess Harris. Aug 2008
4. Involving older people in health research, N. Fudge. Mar 2007
5. Why involve older people in research? Alan Walker. Sep 2007
6. Understanding why older people participate in clinical trials: the experience of the Scottish PROSPER participants, Elizabeth Tolmie. Jan 2004
7. Older people included in a venous thrombo‐embolism clinical trial: a patients'      viewpoint, B. Tardy. Aug 2002
8. The Effect of Participation in a Study on Patents' Perception of Cramp Frequency, C Roffe. 1998 supplement
9. Elderly Volunteer's Opinions and Attitudes to Clinical Research, MT Kinirons.1995 supplement
10. The Attitudes and Experience of Elderly Volunteers Participating in Drug Development Studies, P. Crome. 1995 supplement

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