Strategies to recruit and retain older adults in intervention studies: A quantitative comparative study (original) (raw)
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Age and Ageing, 2017
Background: adults aged ≥65 years are often excluded from health research studies. Lack of representation reduces generalisability of treatments for this age group. Objective: to evaluate the effectiveness of strategies that improve recruitment and retention of adults aged ≥65 in observational studies and randomised controlled trials (RCTs). Methods: searches conducted in 10 databases for RCTs of recruitment and retention strategies in RCTs or observational studies. Two reviewers screened abstracts and full-text articles for eligibility and extracted data. Studies without separate data for adults aged ≥65 were discarded. Risk of bias assessed using the Cochrane Risk of Bias tool. Results were synthesised narratively. Results: thirty-two studies were included in the review (n = 75,444). Twelve studies had low risk of bias, of which 10 had successful strategies including: Opt-out versus opt-in increased recruitment (13.6% (n = 261)−18.7% (n = 36) difference; two studies); Advance notification increased retention (1.6% difference, OR 1.45; 95% CI 1.01, 2.10, one study (n = 2,686); 9.1% difference at 4 months, 1.44; 1.08, 1.92, one study (n = 753)); Hand-delivered versus postal surveys increased response (25.1% difference; X 2 = 11.40, P < 0.01; one study (n = 139)); Open randomised design versus blinded RCT increased recruitment (1.56; 1.05, 2.33) and retention (13.9% difference; 3.1%, 24.6%) in one study (n = 538). Risk of bias was high/ unclear for studies in which incentives or shorter length questionnaires increased response. Discussion: in low risk of bias studies, few of the strategies that improved participation in older adults had been tested in ≥1 study. Opt-out and advance notification strategies improved recruitment and retention, respectively, although an opt-out approach may have ethical limitations. Evidence from single studies limits the generalisability of other strategies.
Age and Ageing, 2021
Background older people remain underrepresented in clinical trials, and evidence generated in younger populations cannot always be generalized to older patients. Objective to identify key barriers and to discuss solutions to specific issues affecting recruitment and retention of older participants in clinical trials based on experience gained from six current European randomised controlled trials (RCTs) focusing on older people. Methods a multidisciplinary group of experts including representatives of the six RCTs held two networking conferences and compiled lists of potential barriers and solutions. Every item was subsequently allocated points by each study team according to how important it was perceived to be for their RCTs. Results the six RCTs enrolled 7,612 older patients. Key barriers to recruitment were impaired health status, comorbidities and diverse health beliefs including priorities within different cultural systems. All trials had to increase the number of recruitment ...
protocols.io, 2019
Importance Importance Elderly patients are underrepresented in clinical trials. Objective Objective To identify barriers and strategies concerning recruitment and retention of elderly patients in clinical trials. Data Source Data Source MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials (via Cochrane Library), Embase (via Ovid) Eligibility Eligibility Publications stemming from original research that report on barriers of or strategies for better recruitment or retention of elderly people. Outcomes Outcomes Barriers and strategies concerning recruitment and retention of elderly people in clinical trials. Critical Appraisal Critical Appraisal This study is about identifying barriers and solutions concerning recruitment and retention of elderly patients in clinical trials. Typical endpoints requiring a risk of bias appraisal such as ones that concern efficacy or safety will not be assessed, consequently, there will be no risk of bias assessments. Furthermore, a very heterogeneous set of studies will be included for which there exists no single risk of bias-assessment tool.
Age and ageing, 2015
There is widespread evidence of under-recruitment of older people to research studies, notably randomised controlled trials of interventions. Study exclusion criteria, ethical dilemmas, patient preference, risk of bias and challenges for treatment comparisons are particular problems faced by researchers. This article describes how more widespread use of the cohort multiple randomised controlled trial (cmRCT) design in ageing research may help address many of these problems. The original key features of the cmRCT design are a large observational cohort of people with the condition of interest (e.g. frailty) with regular measurement of outcomes for the whole cohort. For each RCT eligible patients are identified and a random selection offered the trial intervention; their outcomes are compared with those eligible patients not offered the intervention. Relevant assents are obtained at baseline to enable future involvement in a range of potential trials. Where possible, the follow-up sch...
Recruitment and Retention of Elderly Patients in Clinical Trials: Issues and Strategies
The American Journal of Geriatric Psychiatry, 2001
Clinicians and researchers alike are shifting their focus to elderly patients in order to target the most effective treatments for a variety of psychiatric conditions. Clinical trials with elderly patients are the necessary because they consume the largest number of prescription medications. There are special challenges and considerations in designing and conducting clinical studies. The authors review the various phases of such research, including recruitment of appropriate patients and retention of those enrolled, and they make suggestions, using examples from already completed research studies, illustrating the methods found to be most successful.
Age and Ageing, 2004
Background: over the next 20 years it is anticipated that there will be a significant increase in those aged 75 and over, and a consequent increase in cardiovascular disease, cancer and chronic illness. As this shift takes effect, there will be an increased need for treatment strategies that are of known benefit to this age group and a consequent rise in demand for clinical trials that are conducted specifically with the older population. Because factors that motivate older individuals to participate in clinical trials may differ from those that influence younger adults, it is important to evaluate the strategies used to encourage recruitment and retention and to determine how appropriate these are. Aim: evaluation of the reasons why subjects agree to participate in a controlled clinical trial of vascular disease prevention and the strategies used to improve compliance and protocol adherence. Setting: Scotland. Subjects: 2,520 Prospective Study of Pravastatin in the Elderly at Risk participants, aged 70-82 with either pre-existing vascular disease or at least one major vascular risk factor (hypertension, cigarette smoking, or diabetes mellitus). Design of study: two-stage iterative survey. Stage I was exploratory. Results: curiosity, or an interest in finding out more about the study, 'a desire to support research', and anticipated personal benefits, such as health screening, were the most important motivators for generating initial interest in the trial. Ongoing health monitoring was the most important recruitment and retention motivator (P = 0.001). Conclusions: curiosity, self interest and altruism may act as motivators at different points in the study time-line. However, fostering positive relationships between staff and recruits, and keeping recruits informed about the progress of the study are likely to maximise the retention of older subjects to long-term trials.
Aging Clinical and Experimental Research, 2005
Background and aims: Volunteer bias in intervention studies on successful aging has been poorly explored. This paper investigated differences between participants and non-participants of the Groningen Intervention Study on Successful Aging (GISSA) over a wide range of demographic, physical, psychological and social subject characteristics. Meth ods: Subjects were recruited among a longitudinal co hort study (Groningen Longitudinal Aging Study) and included 558 men and 711 women, aged 65-96 years, who were invited to participate in the GIS SA. Measures were obtained by questionnaires at the moment of invitation and eight years before in vitation. Participants were compared with three groups of non-participants: persons who refused to participate, those who did not respond after a re minder, and those who intended to participate but withdrew before pre-test. Results: At the moment of invitation, participants were younger, better educat ed, and functionally and physically more active than the three groups of non-participants. They also had better scores on the physical functioning subscale of the medical outcome scale, better ADL, iADL and vigorous ADL functions and fewer depressive symptoms, and perceived less social support in ev eryday and problem situations. Participants reported a less strong rate of decline in physical and psycho logical functioning in the eight years prior to the invitation than did the other groups. Conclusion:
PloS one, 2014
People aged 85 and over are often excluded from research on the grounds of being difficult to recruit and problematic to retain. The Newcastle 85+ study successfully recruited a cohort of 854 85-year-olds to detailed health assessment at baseline and followed them up over 3 phases spanning 5 years. This paper describes the effectiveness of its retention strategies. Primary retention strategies involved meticulous management of contact information and active maintenance of contact with participants between research visits and between phases of the study. For statistical analysis, data on post-inclusion attrition over the 3 follow-up phases was separated into 'death' and 'withdrawal' categories, with sub-categories 'health' and 'non-health' reasons created for 'withdrawal'. Multinomial logistic regression was used to determine if particular socio-demographic and health characteristics were associated with post-inclusion attrition due to withdraw...
Recruiting older adults for clinical trials
Controlled Clinical Trials, 1997
More than 400 community-dwelling older adults were recruited into a clinical trial which compared the effectiveness of diagnosis and treatment through geriatric assessment with that provided through usual community physician care. Six recruitment methods were utilized: referrals, solicitations, presentations, media, mailings, and fliers.