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Forman DE, Pignolo RJ. A Pragmatic Approach to Introducing Translational Geroscience Into the Clinic: A Paradigm Based on the Incremental Progression of Aging-Related Clinical Research. J Gerontol A Biol Sci Med Sci 2024; 79:glae062. [PMID: 39126296 PMCID: PMC11316203 DOI: 10.1093/gerona/glae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Indexed: 08/12/2024] Open
Abstract
Geroscience posits that molecular drivers underlie the aging process. Gerotherapeutics entail strategies to counter molecular drivers of aging to reduce the chronic diseases and geriatric syndromes they trigger. Although the concept of gerotherapeutics for prevention has generated much excitement, the implications of prescribing potentially harmful medications to older adults who are "healthy" have been associated with many delays. Concerns regarding safety and valid endpoints have contributed to holdups. In contrast, it has been relatively easier to implement trials of medications with gerotherapeutic properties as novel approaches to remedy disease. In these applications, the risks of the medications are easier to justify when therapeutic benefits are perceived as outweighing the harms of the disease. Likewise, metrics of effective disease treatments are often seen as more reliable and quantifiable than metrics of health prolongation. Overall, clarifying geroscience mechanisms in disease therapeutic applications provides key opportunities to advance translational geroscience, especially as preventive geroscience trials are often encumbered. In this review, gerotherapeutic benefits of canakinumab, cholchicine, and zoledronic acid as parts of disease management are considered. Longevity Clinics and other opportunities to advance translational geroscience as parts of contemporary care are also discussed.
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Affiliation(s)
- Daniel E Forman
- Department of Medicine, Geriatrics and Cardiology, University of Pittsburgh and Pittsburgh Geriatrics, Research, and Clinical Center (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Robert J Pignolo
- Department of Medicine (Divisions of Hospital Internal Medicine, Endocrinology, and Section on Geriatric Medicine & Gerontology), Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Bowling CB, Berkowitz TSZ, Burrows BT, Ma JE, Whitson HE, Smith B, Crowley SD, Wang V, Maciejewski ML, Olsen MK. Trajectories of Physical Resilience Among Older Veterans With Stage 4 CKD. Am J Kidney Dis 2024; 84:154-163. [PMID: 38484869 DOI: 10.1053/j.ajkd.2024.01.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/15/2024] [Accepted: 01/28/2024] [Indexed: 04/26/2024]
Abstract
RATIONALE & OBJECTIVE Although functional impairment is common among older adults with chronic kidney disease (CKD), functional reserve before an acute health event and physical resilience after the event have not been characterized in this population. The purpose of this study was to identify distinct patterns of physical function before and after an acute health event among older veterans with stage 4 CKD. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS National sample of veterans≥70 years of age with an estimated glomerular filtration rate (eGFR) of<30mL/min/1.73m2 who had an acute care encounter (emergency department visit or hospitalization) during the follow-up period (n = 272). PREDICTORS Demographic characteristics, eGFR, basic and instrumental activities of daily living (ADL/IADL) difficulty, symptom burden, cognition, depressive symptoms, social support. OUTCOME Function measured using the life-space mobility assessment obtained by telephone survey before and after an acute care encounter. ANALYTICAL APPROACH General growth mixture models to identify classes of functional trajectories. Calculation of percentages for demographic characteristics and means for eGFR, ADL/IADL difficulty, symptom burden, cognition, depressive symptoms, and social support by trajectory class. RESULTS Four trajectory classes were identified and characterized by different levels of life-space mobility before (reserve) and change in life-space mobility after (resilience) an acute care encounter: (1) low reserve, low resilience (n=91), (2) high reserve, high resilience (n=23), (3) moderate reserve, moderate resilience (n=89), and (4) high reserve, low resilience (n=69). Mean levels of ADL/IADL difficulty, symptom burden, cognition, and depressive symptoms, but not demographic characteristics, eGFR, or social support, differed by trajectory class. LIMITATIONS Veteran cohort was primarily male. CONCLUSIONS Among older adults with stage 4 CKD, physical function trajectories before and after an acute health event vary. Integrating reserve and resilience into care for this population may be useful for anticipating changes in function and developing tailored treatment plans.
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Affiliation(s)
- C Barrett Bowling
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham, North Carolina; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina; Center for the Study of Aging and Human Development (the Aging Center), Duke University, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina.
| | - Theodore S Z Berkowitz
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina
| | - Brett T Burrows
- Center for the Study of Aging and Human Development (the Aging Center), Duke University, Durham, North Carolina
| | - Jessica E Ma
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina
| | - Heather E Whitson
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham, North Carolina; Center for the Study of Aging and Human Development (the Aging Center), Duke University, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina
| | - Battista Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina
| | - Steven D Crowley
- Durham Veterans Affairs Health Care System, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina
| | - Virginia Wang
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Maren K Olsen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
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Alibhai SMH, Puts M, Jin R, Godhwani K, Antonio M, Abdallah S, Feng G, Krzyzanowska MK, Soto-Perez-de-Celis E, Papadopoulos E, Mach C, Nasiri F, Sridhar SS, Glicksman R, Moody L, Bender J, Clarke H, Matthew A, McIntosh D, Klass W, Emmenegger U. TOward a comPrehensive supportive Care intervention for Older men with metastatic Prostate cancer (TOPCOP3): A pilot randomized controlled trial and process evaluation. J Geriatr Oncol 2024; 15:101750. [PMID: 38521641 DOI: 10.1016/j.jgo.2024.101750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Current management of metastatic prostate cancer (mPC) includes androgen receptor axis-targeted therapy (ARATs), which is associated with substantial toxicity in older adults. Geriatric assessment and management and remote symptom monitoring have been shown to reduce toxicity and improve quality of life in patients undergoing chemotherapy, but their efficacy in patients being treated with ARATs has not been explored. The purpose of this study is to examine whether these interventions, alone or in combination, can improve treatment tolerability and quality of life (QOL) for older adults with metastatic prostate cancer on ARATs. MATERIALS AND METHODS TOPCOP3 is a multi-centre, factorial pilot clinical trial coupled with an embedded process evaluation. The study includes four treatment arms: geriatric assessment and management (GA + M); remote symptom monitoring (RSM); geriatric assessment and management plus remote symptom monitoring; and usual care and will be followed for six months. The aim is to recruit 168 patients between two cancer centres in Toronto, Canada. Eligible participants will be randomized equally via REDCap. Participants in all arms will complete a comprehensive baseline assessment upon enrollment following the Geriatric Core dataset, as well as follow-up assessments at 1.5, 3, 4.5, and 6 months. The co-primary outcomes will be grade 3-5 toxicity and QOL. Toxicities will be graded using the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. QOL will be measured by patient self-reporting using the EuroQol 5 dimensions of health questionnaire. Secondary outcomes include fatigue, insomnia, and depression. Finally, four process evaluation outcomes will also be observed, namely feasibility, fidelity, and acceptability, along with implementation barriers and facilitators. DISCUSSION Data will be collected to observe the effects of GA + M and RSM on QOL and toxicities experienced by older adults receiving ARATs for metastatic prostate cancer. Data will also be collected to help the design and conduct of a definitive multicentre phase III randomized controlled trial. This study will extend supportive care interventions for older adults with cancer into new areas and inform the design of larger trials. TRIAL REGISTRATION The trial is registered at clinicaltrials.gov (registration number: NCT05582772).
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Affiliation(s)
- Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Ontario, Canada.
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Rana Jin
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Kian Godhwani
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Maryjo Antonio
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Soha Abdallah
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Gregory Feng
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Calvin Mach
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Ferozah Nasiri
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Srikala S Sridhar
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Rachel Glicksman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network; Department of Radiation Oncology, University of Toronto, Canada
| | - Lesley Moody
- Varian Medical Systems, Winnipeg, Manitoba, Canada
| | - Jacqueline Bender
- Department of Supportive Care, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Andrew Matthew
- Department of Surgical Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | | | | | - Urban Emmenegger
- Division of Medical Oncology & Hematology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Gosselin M, Baroud ML, Denis OR, Gagnon ME, Sirois C. Evidence-based data for newly approved medications' use in older adults: An analysis from clinical trials to monographs. J Am Geriatr Soc 2024; 72:1252-1262. [PMID: 38270204 DOI: 10.1111/jgs.18772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/05/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Older adults have historically been excluded from clinical trials, limiting evidence-based data. An updated picture of the situation with newly marketed medications is needed. We aimed to describe (1) the recommendations specific to older adults in monographs of newly marketed medications; (2) the representation of older adults in clinical trials of those medications. METHODS In November 2020, we listed all medications that received a notice of compliance from Health Canada between January 2006 and September 2020, excluding those with indications irrelevant to community-dwelling older adults and locally acting medications. We assessed the availability and clarity of recommendations in monographs regarding older adults. Using Clinicaltrials.gov, we identified randomized controlled double-blind Phase III-IV trials led in Canada/United States of a sample of 30 commonly used medications among those previously listed. We extracted information on study design, participants, and efficacy/safety analysis specific to older patients. We used simple linear regression and Chi-square/Fisher's exact tests to analyze time trends in the representation of older adults over different periods. RESULTS A total of 195 monographs were included. Of the 130 monographs reporting a dosing recommendation in older adults, 53 (41%) also reported limited/insufficient data in this population or its subgroups. Of the 373 trials included, 217 (58%) did not integrate a maximum age as an inclusion criterion. However, only 113 (30%) reported including a proportion of older adults representative (or over-representative) of the Canadian older population. Most trials (n = 289; 78%) did not provide efficacy or safety data specific to older adults. In our sample, the number/proportion of older adults in trials seemed to be increasingly reported over time, either explicitly or implicitly (e.g., inclusion criterion specifies <65 years old). CONCLUSIONS Newly marketed medications still appear to under-represent older adults. The resulting lack of clear recommendations in monographs compromises evidence-based practice, thereby perpetuating the risk to older adults' health.
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Affiliation(s)
- Maude Gosselin
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | | | | | - Marie-Eve Gagnon
- Faculty of Pharmacy, Université Laval, Quebec, Quebec, Canada
- Department of Health Sciences, Université du Québec à Rimouski, Rimouski, Quebec, Canada
| | - Caroline Sirois
- Faculty of Pharmacy, Université Laval, Quebec, Quebec, Canada
- Centre d'excellence sur le vieillissement de Québec, Quebec, Quebec, Canada
- VITAM, Sustainable Health Research Centre, Quebec, Quebec, Canada
- CHU de Québec-Université Laval Research Centre, Quebec, Quebec, Canada
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Jacobson RM, Pignolo RJ, Lazaridis KN. Clinical Trials for Special Populations: Children, Older Adults, and Rare Diseases. Mayo Clin Proc 2024; 99:318-335. [PMID: 38309939 PMCID: PMC10842263 DOI: 10.1016/j.mayocp.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/02/2023] [Accepted: 03/13/2023] [Indexed: 02/05/2024]
Abstract
Research cannot maximize population health unless it improves health for all members of the public, including special populations such as children, older adults, and people living with rare diseases. Each of these categories require special considerations when planning and performing clinical trials, and common threads of ethical conduct of research in vulnerable populations appear throughout. In this review, definitions of each of the three categories of special population (children, older adults, and rare diseases) are discussed in terms of US research regulations, the unique challenges to conducting clinical trials for these special populations, critical ethical issues, and opportunities for innovative ways to design and operationalize clinical trials in special populations. Additional critical attention is focused on factors that influence the generalizability of study results to reduce health disparities, as well as the importance of community engagement and advocacy groups that can help to educate potential trial participants of the benefits of clinical trial participation.
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Affiliation(s)
- Robert M Jacobson
- Department of Pediatric and Adolescent Medicine and Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
| | - Robert J Pignolo
- Department of Medicine and Divisions of Hospital Internal Medicine and Endocrinology, Home of Medical Excellence in Geriatric Medicine and Gerontology, Department of Physiology and Biomedical Engineering, and Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA
| | - Konstantinos N Lazaridis
- Center for Individualized Medicine, Department of Internal Medicine, Division of Gastroenterology, Mayo Clinic, Rochester, MN, USA
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Goldstein KM, Kung LCY, Dailey SA, Kroll-Desrosiers A, Burke C, Shepherd-Banigan M, Lumsden R, Sims C, Schexnayder J, Patel D, Cantrell S, Sheahan KL, Gierisch JM. Strategies for enhancing the representation of women in clinical trials: an evidence map. Syst Rev 2024; 13:2. [PMID: 38166994 PMCID: PMC10759390 DOI: 10.1186/s13643-023-02408-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Equitable sex- and gender-based representation in clinical trials is an essential step to ensuring evidence-based care for women. While multi-institutional actions have led to significant improvements in the inclusion of women in trials, inequity persists in areas like sex-neutral cancers and cardiovascular disease. We sought to identify strategies described or evaluated to boost the inclusion of women in clinical trials. METHODS We used evidence mapping methodology to examine the breadth of relevant literature. We developed an a priori protocol and followed reporting guidance from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis where applicable. We searched MEDLINE® (via PubMed) and EMBASE (via Elsevier) databases from inception through April 4, 2023, and used standardized procedures incorporating duplication and data verification. We included articles that described strategies to improve the recruitment and retention of women in clinical trials. RESULTS We identified 122 articles describing recruitment and retention strategies for 136 trials (377,595 women). Only one article distinguished between the sex and gender identity of participants, and none defined their use of the terms such as "women" or "female". The majority of articles (95%) described recruitment for only women, and 64% were conducted in the USA. Ninety-two articles (75%) described strategies in the context of sex-specific conditions (e.g., gynecologic diagnosis). The majority of included articles evaluated a behavioral intervention (52%), with 23% evaluating pharmacologic interventions and 4% invasive interventions. The most common trial phase for reported strategies was during outreach to potential participants (116 articles), followed by intervention delivery (76), enrollment (40), outcomes assessment (21), analysis and interpretation (3), and dissemination (4). We describe specific types of strategies within each of these phases. CONCLUSIONS Most of the existing literature describing strategies to improve the inclusion of women draws from trials for sex-specific conditions and is largely related to outreach to potential participants. There is little information about how and if studies have attempted to proportionally increase the inclusion of women in trials with both men and women or those focused on invasive and pharmacologic interventions. Future work in this area should focus on how to increase the participation of women in mixed-sex studies and on those areas with remaining inequities in trial participation.
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Affiliation(s)
- Karen M Goldstein
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.
- Division of General Internal Medicine, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC, 27710, USA.
| | - Lindsay Chi Yan Kung
- Health Management & Policy, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4162, USA
| | - Susan Alton Dailey
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, 421 North Main Street, Leeds, MA, 01053, USA
- UMass Chan Medical School, 55 Lake Ave. N, Worcester, MA, 01655, USA
| | - Colleen Burke
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
| | - Megan Shepherd-Banigan
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
- Duke-Margolis Center for Health Policy, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
| | - Rebecca Lumsden
- Division of General Internal Medicine, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC, 27710, USA
| | - Catherine Sims
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Duke Rheumatology Division, 40 Duke Medicine Circle Clinic 1j, Durham, NC, 27710, USA
| | - Julie Schexnayder
- University of Alabama at Birmingham School of Nursing, NB545 1720 2nd, Ave S, Birmingham, AL, 35294, USA
| | - Dhara Patel
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Sarah Cantrell
- Duke University Medical Center Library & Archives, Duke University School of Medicine 10 Searle Drive, Durham, NC, 27710, USA
| | | | - Jennifer M Gierisch
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Division of General Internal Medicine, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC, 27710, USA
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
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De Lima B, Lindauer A, Eckstrom E. Age-Friendly Research: A Pilot Exploration of Tools to Facilitate Inclusion of Older Adults in Research. Gerontol Geriatr Med 2024; 10:23337214241236037. [PMID: 38435474 PMCID: PMC10906043 DOI: 10.1177/23337214241236037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/05/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
Older adults have a high burden of chronic diseases but are underrepresented in research. Researchers with geriatric or gerontology expertise have developed frameworks to recruit and retain older adults but these have not been widely adopted by the broader research community. We developed or adapted seven Age-Friendly research tools and invited research team members with no aging training to pilot test them. We consented 21 research team members and asked them to share strengths, limitations, and areas for improvement for each tool for up to 4 months via REDCap surveys. Sixteen participants (76%) completed at least one survey. The communication guide and Age-Friendly research checklist were the most utilized tools among participants. Key barriers to implementation were lack of time and lack of age-appropriate populations. Facilitators of tool implementation were accessibility and ease of use, webinar training, and supportive teams. Participants found the tools valuable to encourage Age-Friendly research studies. Adoption of Age-Friendly research tools could improve the experience for research team members and older adults alike.
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Affiliation(s)
- Bryanna De Lima
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - Allison Lindauer
- Oregon Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR, USA
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Nguyen QD, Forget MF, Zhang XS, Richer C, Podbielski R, Gaudreau P, Desmarais P. Systematic review of research barriers, facilitators, and stakeholders in long-term care and geriatric settings, and a conceptual mapping framework to build research capacity. BMC Geriatr 2023; 23:622. [PMID: 37794339 PMCID: PMC10552295 DOI: 10.1186/s12877-023-04318-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 09/14/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Older adults are underrepresented in research. Heterogeneity of research processes in this population, specifically in long-term care (LTC) and geriatric acute care (GAC), is not well described and may impede the design, planning, and conduct of research. In this study, we identified, quantified, and mapped stakeholders, research stages, and transversal themes of research processes, to develop a mapping framework to improve research capacity by better characterizing this heterogeneity. METHODS Multicomponent mixed methods study. An environmental scan was used to initiate a preliminary framework. We conducted a systematic literature search on processes, barriers, and methods for clinical research in GAC and LTC to extract and update stakeholders, research stages, and themes. Importance and interactions of elements were synthesized via heatmaps by number of articles, mentions, and content intersections. RESULTS For our initial framework and environmental scan, we surveyed 24 stakeholders. Of 9277 records, 68 articles were included in our systematic review and allowed us to identify 12 stakeholders, 13 research stages, 17 transversal themes (either barriers, facilitators, general themes, or recommendations), and 1868 intersections. Differences in relative importance between LTC and GAC emerged for stakeholders (staff, managers vs. caregivers, ethics committees), and for research stages (funding, facility recruitment vs. ethics, individual recruitment). Crucial themes according to specific stakeholders were collaboration for the research team; communication, trust, and human resources for managers; heterogeneity for patients and residents. A heatmap framework synthesizing vital stakeholders and themes per research stage was generated. CONCLUSIONS We identified and quantified the interactions between stakeholders, stages, and themes to characterize heterogeneity in LTC and GAC research. Our framework may serve as a blueprint to co-construct and improve each stage of the research process.
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Affiliation(s)
- Quoc Dinh Nguyen
- Division of Geriatrics, Centre hospitalier de l'Université de Montréal, Montreal, Canada.
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada.
- Department of Medicine, Université de Montréal, Montreal, Canada.
| | - Marie-France Forget
- Division of Geriatrics, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Medicine, Université de Montréal, Montreal, Canada
| | - Xi Sophie Zhang
- Department of General Medicine, Centre intégré de santé et de services sociaux du Centre- Sud-de-l'île-de-Montréal, Montreal, Canada
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Canada
| | - Catherine Richer
- Department of General Medicine, Centre intégré de santé et de services sociaux du Centre- Sud-de-l'île-de-Montréal, Montreal, Canada
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Canada
| | - Renata Podbielski
- Direction of Teaching and the CHUM Académie, Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Pierrette Gaudreau
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Medicine, Université de Montréal, Montreal, Canada
| | - Philippe Desmarais
- Division of Geriatrics, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Medicine, Université de Montréal, Montreal, Canada
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9
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Ma JE, Berkowitz TS, Olsen MK, Smith B, Lorenz KA, Bowling CB. Phenotypes of Symptom, Function, and Medication Burden in Older Adults with Nondialysis Advanced Kidney Disease. KIDNEY360 2023; 4:1430-1436. [PMID: 37682550 PMCID: PMC10615372 DOI: 10.34067/kid.0000000000000241] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023]
Abstract
Key Points There are three distinct classes of symptoms, functional impairment, and medication burden among older adults with advanced kidney disease. One class with Complex Needs with pain and psychological symptoms, functional difficulties, and polypharmacy may benefit from tailored multidisciplinary care. Background Older adults with advanced CKD (stages 4 and 5) have significant symptoms, polypharmacy, and functional difficulties, and previous studies evaluated these burdens separately. Identifying subgroups with similar patterns of burdens could help clinicians optimize care for these individuals. Methods We conducted a secondary analysis of 377 older participants (70 years and older) with stage 4 and 5 CKD at high risk of hospitalization enrolled in a national Veterans Affairs prospective cohort study. Adults on dialysis or with prior kidney transplant were excluded. We used latent class analysis to identify participants with similar patterns across symptoms, medication burden, and function. Sixteen variables were included: symptoms (anxiety, depression, appetite, pain, shortness of breath, fatigue, dizziness, leg weakness, constipation, and stiffness using the Symptom Burden Score), polypharmacy (≥10 medications and potentially inappropriate medications), and function (activities of daily living [ADLs], physical and cognitive instrumental ADLs [IADLs], and falls in the past year). We also compared 12-month hospitalization and mortality rates between the three classes. Results Three classes of participants with similar functional impairment, medication burden, and symptom phenotypes were identified. The largest participant class (N =208) primarily had difficulties with physical IADLs and polypharmacy. The second participant class (N =99) had shortness of breath, constipation, and dizziness. The third participant class (N =70) had complex needs with daily pain, psychological symptoms (anxiety and depression), functional limitations (ADLs and physical and cognitive IADLs), and polypharmacy. The three classes had significantly different levels of comorbidities, financial stress, and social support. There were no significant differences in mortality and hospitalization among the three classes. Conclusion There are distinct classes of older adults with advanced CKD who have physical and psychological symptoms, functional impairment, and medication burden. Tailoring care for this population should include a multidisciplinary team to address these overlapping symptoms, medication, and functional needs.
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Affiliation(s)
- Jessica E. Ma
- Geriatric Research Education and Clinical Center, Durham VA Health System, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Theodore S.Z. Berkowitz
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina
| | - Maren K. Olsen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Battista Smith
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina
| | - Karl A. Lorenz
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - C. Barrett Bowling
- Geriatric Research Education and Clinical Center, Durham VA Health System, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Center for the Study of Aging, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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10
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De Lima B, Lindauer A, Eckstrom E. Age-Friendly Research: promoting inclusion of older adults in clinical and translational research. J Clin Transl Sci 2023; 7:e200. [PMID: 37830011 PMCID: PMC10565191 DOI: 10.1017/cts.2023.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/02/2023] [Accepted: 08/27/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction Older adults have a high disease burden but are often underrepresented in research studies due to recruitment and retention obstacles, among others. Geriatric research specialists have identified solutions to these challenges and designed frameworks to help other researchers. Our team utilized three frameworks to create an interactive webinar series aimed to educate research team members on Age-Friendly practices. Methods We recruited 40 non-aging-trained research team members to participate in a six-session, real-time webinar series from October to November 2022. Sessions were comprised of 20-30 minute didactics and 30-40 minute group discussions. Participants completed pre- and post-program surveys, commitment to change forms, and post-webinar session surveys. Responses were examined for strengths and areas for improvement. Wilcoxon signed-rank tests assessed differences in confidence scores. Results Self-reported confidence scores improved after the webinar series. Most participants provided positive feedback and high likeliness to use what they learned and recommend the webinar to others. The strengths were practical tips, applicable tools, and real-world examples. The major area for improvement was information on industry-sponsored trials. The commitment to change responses varied from pledging to use more inclusive language to adapting materials to improve the consent process. Conclusion This interactive Age-Friendly Research webinar series was feasible and well received by participants. We created an Age-Friendly Research community fostering commitment to change clinical and translational research to be more inclusive of older adults. Future work will include more information on industry-sponsored trials and expand to other research centers.
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Affiliation(s)
- Bryanna De Lima
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - Allison Lindauer
- Oregon Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR, USA
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Pinho-Gomes AC, Carcel C, Woodward M, Hockham C. Women's representation in clinical trials of patients with chronic kidney disease. Clin Kidney J 2023; 16:1457-1464. [PMID: 37664564 PMCID: PMC10469102 DOI: 10.1093/ckj/sfad018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Indexed: 09/05/2023] Open
Abstract
Background Sex and gender differences in chronic kidney disease (CKD), including epidemiology and response to treatment, remain poorly understood. This study aimed to investigate how women are represented in CKD clinical trials and whether sex- and gender-disaggregated outcomes were reported. Methods Clinical trials on CKD were identified from ClinicalTrials.gov. Randomised, phase 3/4 trials with ≥100 participants were selected to quantify women's representation among participants by computing the participation:prevalence ratio (PPR) and investigating whether sex-disaggregated analyses had been performed. Results In total, 192 CKD trials registered on ClinicalTrials.gov and published between 1995 and 2022 were included. Overall, women accounted for 66 875 (45%) of the 147 136 participants. Women's participation in clinical trials was lower than their representation in the underlying CKD population globally (55%). The PPR was 0.75 (95% confidence interval 0.72-0.78), with no significant variation irrespective of mean age, CKD stage, dialysis, location, type of intervention or funding agency. A total of 39 (20%) trials reported sex-disaggregated efficacy outcomes and none reported sex-disaggregated safety outcomes. Conclusion Women's participation in CKD clinical trials was lower than their representation in the underlying CKD population. Sex-disaggregated efficacy and safety outcomes were rarely reported. Improving women's enrolment into clinical trials is crucial to enable sex- and gender-disaggregated analysis and thus identify potential differences in treatment response between women and men.
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Affiliation(s)
- Ana-Catarina Pinho-Gomes
- The George Institute for Global Health, Imperial College London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Cheryl Carcel
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Sydney School of Public Health, Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Mark Woodward
- The George Institute for Global Health, Imperial College London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Carinna Hockham
- The George Institute for Global Health, Imperial College London, UK
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12
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Thomas J, Eckstrom E, Lam K, Sullivan S, Bentley-Edwards K, Gierisch JM, Bowling CB. Recommendations for using the 5Ts Framework to support research inclusion across the lifespan. J Am Geriatr Soc 2023; 71:2664-2669. [PMID: 37036034 PMCID: PMC10495931 DOI: 10.1111/jgs.18359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/14/2023] [Accepted: 03/07/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Jennifer Thomas
- Department of Population Health Sciences, Duke University, Durham, NC
| | - Elizabeth Eckstrom
- Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, OR
- Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland, OR
| | - K.K. Lam
- Duke Clinical & Translational Science Institute, School of Medicine, Duke University, Durham, NC
| | - Sydney Sullivan
- Duke Clinical & Translational Science Institute, School of Medicine, Duke University, Durham, NC
| | - Keisha Bentley-Edwards
- Samuel DuBois Cook Center On Social Equity, School of Medicine, Duke University, Durham, NC
| | - Jennifer M. Gierisch
- Department of Population Health Sciences, Duke University, Durham, NC
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC
| | - C. Barrett Bowling
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), Durham, NC
- Divison of Geriatric Medicine, Department of Medicine, Duke University, Durham, NC
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13
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Bowling CB, Thomas J, Gierisch JM, Bosworth HB, Plantinga L. Research Inclusion Across the Lifespan: A Good Start, but There Is More Work to Be Done. J Gen Intern Med 2023; 38:1966-1969. [PMID: 37002458 PMCID: PMC10272002 DOI: 10.1007/s11606-023-08182-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/20/2023] [Indexed: 06/17/2023]
Abstract
While older adults account for a disproportionate amount of healthcare spending, they are often underrepresented in clinical research needed to guide clinical care. The purpose of this perspective is to make readers aware of new data on age at enrollment for participants included in National Institutes of Health (NIH)-funded clinical research. We highlight key findings of relevance to general internal medicine and suggest ways readers could support the inclusion of older adults in clinical research. Data from the NIH Research Inclusion Statistics Report show that there were 881,385 participants enrolled in all NIH-funded clinical research in 2021, of whom 170,110 (19%) were 65 years and older. However, on average, studies included a far lower percentage of older adults. Additionally, there were many conditions for which overall enrollment rates for older adults were lower than would be expected. For example, while 10% of participants in studies related to diabetes were ≥ 65 years old, older individuals represent 43% of all prevalent diabetes in the USA. Researchers should work with clinicians to advocate for older adults and ensure their participation in clinical research. Best practices and resources for overcoming common barriers to the inclusion of older adults in research could also be disseminated.
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Affiliation(s)
- C Barrett Bowling
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), Durham, NC, USA.
- Department of Medicine, Duke University, Durham, NC, USA.
| | - Jennifer Thomas
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Jennifer M Gierisch
- Department of Medicine, Duke University, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Hayden B Bosworth
- Department of Medicine, Duke University, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Laura Plantinga
- Department of Medicine, Emory University, Atlanta, GA, USA
- Department of Epidemiology, Emory University, Atlanta, GA, USA
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Goodwin VA, Low MSA, Quinn TJ, Cockcroft EJ, Shepherd V, Evans PH, Henderson EJ, Mahmood F, Ni Lochlainn M, Needham C, Underwood BR, Arora A, Witham MD. Including older people in health and social care research: best practice recommendations based on the INCLUDE framework. Age Ageing 2023; 52:afad082. [PMID: 37261448 PMCID: PMC10234283 DOI: 10.1093/ageing/afad082] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Older people are often explicitly or implicitly excluded from research, in particular clinical trials. This means that study findings may not be applicable to them, or that older people may not be offered treatments due to an absence of evidence. AIMS The aim of this work was to develop recommendations to guide all research relevant to older people. METHODS A diverse stakeholder group identified barriers and solutions to including older people in research. In parallel, a rapid literature review of published papers was undertaken to identify existing papers on the inclusion of older people in research. The findings were synthesised and mapped onto a socio-ecological model. From the synthesis we identified themes that were developed into initial recommendations that were iteratively refined with the stakeholder group. RESULTS A range of individual, interpersonal, organisational, community and policy factors impact on the inclusion of older people in research. A total of 14 recommendations were developed such as removing upper age limits and comorbidity exclusions, involving older people, advocates and health and social care professionals with expertise in ageing in designing the research, and considering flexible or alternative approaches to data collection to maximise opportunities for participation. We also developed four questions that may guide those developing, reviewing and funding research that is inclusive of older people. CONCLUSION Our recommendations provide up to date, practical advice on ways to improve the inclusion of older people in health and care research.
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Affiliation(s)
| | - Mikaela S A Low
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Terence J Quinn
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Emma J Cockcroft
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Philip H Evans
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- National Institute for Health and Care Research, Clinical Research Network, UK
| | - Emily J Henderson
- Ageing and Movement Disorders Research Group, Bristol Medical School, University of Bristol, Bristol, UK
| | - Farhat Mahmood
- Academic Unit for Ageing and Stroke Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Mary Ni Lochlainn
- National Institute for Health and Care Research, Clinical Research Network, UK
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | | | | | - Amit Arora
- Elderly Care Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Miles D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Newcastle University, Newcastle, UK
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15
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Eckstrom E, Zauflik M, De Lima B. Matching enrolled trial participants to disease demographics: Using IRB submissions to identify opportunities for researcher training. J Clin Transl Sci 2023; 7:e114. [PMID: 37313384 PMCID: PMC10260342 DOI: 10.1017/cts.2023.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 06/15/2023] Open
Abstract
Background Many diseases are highly prevalent in older adults, yet older adults are often underrepresented in corresponding trials. Our objectives were to (1) determine alignment between Institutional Review Board (IRB) protocol age ranges and enrollment demographics to disease demographics pre- and post-implementation of the 2019 National Institutes of Health (NIH) Lifespan Policy and (2) raise awareness about inclusive recruitment to principal investigators (PIs). Methods This was a pre-post study. We reviewed investigator-initiated studies meeting eligibility criteria at Oregon Health & Science University from 2017 to 2018 to determine baseline alignment. Alignment was defined by the level of matching between protocol/enrollment age and disease demographics: 2 points for full match, 1 point for partial match, and 0 points for mismatch. After the NIH policy implementation, we reviewed new studies for alignment. When a mismatch was determined, we contacted PIs (either at initial IRB protocol submission or during ongoing recruitment) to raise awareness and provide strategies to expand inclusion of older adults in their trials. Results Studies that matched IRB protocol ages to disease demographics significantly improved from 78% pre-implementation to 91.2% post-implementation. Similarly, study enrollment ages matching disease demographics increased by 13.4% following the implementation (74.5%-87.9%). Out of 18 post-implementation mismatched studies, 7 PIs accepted a meeting and 3 subsequently changed their protocol age ranges. Conclusion This study highlights strategies that translational institutes and academic institutions could use to identify research studies whose participants do not align with disease demographics, offering opportunities for researcher awareness and training to enhance inclusion.
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Affiliation(s)
- Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
- Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Meredith Zauflik
- Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Bryanna De Lima
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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Burrows B, DePasquale N, Ma J, Bowling CB. The potential of mHealth for older adults on dialysis and their care partners: What's been done and where do we go from here? FRONTIERS IN NEPHROLOGY 2023; 2:1068395. [PMID: 37675008 PMCID: PMC10479574 DOI: 10.3389/fneph.2022.1068395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/16/2022] [Indexed: 09/08/2023]
Abstract
Self-care, or the dynamic, daily process of becoming actively involved in one's own care, is paramount to prevent and manage complications of end-stage kidney disease. However, many older dialysis patients face distinctive challenges to adequate engagement in self-care. One promising strategy for facilitating self-care among older dialysis patients and their care partners is the utilization of mobile health (mhealth). mHealth encompasses mobile and wireless communication devices used to improve healthcare delivery, patient and care partner outcomes, and patient care. In other disease populations, mHealth has been linked to maintenance of or improvements in self-management, medication compliance, patient education, and patient-provider communication, all of which can slow disease progression. Although mHealth is considered feasible, acceptable, and clinically useful, this technology has predominately targeted younger patients. Thus, there is a need to develop mHealth for older dialysis patients and their care partners. In this article, we describe current mHealth usage in older dialysis patients, including promising findings, challenges, and research gaps. Given the lack of research on mHealth among care partners of older dialysis patients, we highlight lessons learned from other disease populations to inform the future design and implementation of mHealth for these key stakeholders. We also propose that leveraging care partners represents an opportunity to meaningfully tailor mHealth applications and, by extension, improve care partner physical and mental health and decrease caregiver burden. We conclude with a summary of future directions to help older dialysis patients and their care partners receive recognition as target end-users amid the constant evolution of mHealth.
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Affiliation(s)
- Brett Burrows
- Center for the Study of Aging and Human Development, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Nicole DePasquale
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Jessica Ma
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Geriatric Research, Education, and Clinical Center, Durham Veteran Affairs Health Care System (VAHCS), Durham, NC, United States
| | - C. Barrett Bowling
- Center for the Study of Aging and Human Development, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Geriatric Research, Education, and Clinical Center, Durham Veteran Affairs Health Care System (VAHCS), Durham, NC, United States
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VACHS, Durham, NC, United States
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, United States
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Milani SA, Cottler LB, Striley CW. Perceptions of Research Participation among a Sample of Florida Residents Aged 50 and Over Reporting Dementia. AGEING INTERNATIONAL 2023; 48:95-107. [PMID: 34483405 PMCID: PMC8406007 DOI: 10.1007/s12126-021-09441-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 11/17/2022]
Abstract
As the population ages, the prevalence of dementia will increase. More research is needed; however, low rates of research participation, especially by older adults, hinder progress. Data came from HealthStreet, a University of Florida community engagement program in which community health workers assess community members for their health conditions. Adults 50 and over were included in these analyses; their perceptions of health research studies were assessed. Our sample had an average age of 60.5 years and 4.3% reported dementia (n = 4,881). Overall, older adults reported a high willingness to participate in research. Individuals who reported dementia had 0.64 times the odds of reporting willingness to participate in a research study that required an overnight stay, compared to those who did not report dementia (95% CI: 0.45-0.89). We report on willingness to participate in research in a more granular basis than has been previously done. Community members reporting dementia, compared to those without, were as or more likely to desire future participation in health research. However, barriers to participation remain and must be addressed.
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Affiliation(s)
- Sadaf Arefi Milani
- grid.176731.50000 0001 1547 9964Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX USA
| | - Linda B. Cottler
- grid.15276.370000 0004 1936 8091Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL USA
| | - Catherine W. Striley
- grid.15276.370000 0004 1936 8091Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL USA
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18
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Bowling CB, Olsen MK, Berkowitz TSZ, Smith B, Floyd B, Majette N, Miles AL, Crowley SD, Wang V, Maciejewski ML, Whitson HE. Reserve and resilience in CKD: concept introduction and baseline results from the Physical REsilience Prediction in Advanced REnal Disease (PREPARED) study. BMC Nephrol 2022; 23:418. [PMID: 36585609 PMCID: PMC9803898 DOI: 10.1186/s12882-022-03033-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/06/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The purpose of this manuscript is to introduce reserve and resilience as novel concepts in chronic kidney disease (CKD) research and present baseline data from a unique prospective cohort study designed to characterize recovery from functional decline after a health event. METHODS The Physical REsilience Prediction in Advanced REnal Disease (PREPARED) study recruited a national, prospective cohort of Veterans ≥70 years old with an estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73 m2, prior nephrology care, and at high risk for hospitalization. Electronic health record data were paired with telephone surveys. Self-reported measures of reserve included physical, psychological, and cognitive capacity and environmental resources. We calculated counts (frequencies) and medians (25th, 75th percentiles) for baseline measures of reserve. The study's longitudinal follow-up of physical function every 8 weeks or following an acute care encounter, which will be used to define resilience, is ongoing. RESULTS Participants had a median (25th, 75th percentile) age of 76.3 (72.8, 81.4) years and eGFR of 23.4 (18.2, 28.8) ml/min/1.73 m2; 23.3% were Black, and 97.4% were male, 91.6% had hypertension, 67.4% had diabetes mellitus, 46.0% had coronary heart disease, and 39.8% had heart failure. Baseline measures of physical, psychological, and cognitive domains showed low reserve on average, but with wide ranges. CONCLUSIONS Despite similar levels of kidney function, older adults participating in PREPARED had a wide range of measures of reserve in other health domains. Non-renal measures of reserve may be important indicators of capacity of CKD patients to recover after acute care encounters.
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Affiliation(s)
- C. Barrett Bowling
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Health Care System (VAHCS), Durham, NC USA ,Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Center for the Study of Aging and Human Development (the Aging Center), Duke University, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Department of Medicine, Duke University, Durham, NC USA
| | - Maren K. Olsen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Department of Biostatistics and Bioinformatics, Duke University, Durham, USA
| | - Theodore S. Z. Berkowitz
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC USA
| | - Battista Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC USA
| | - Breana Floyd
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC USA
| | - Nadya Majette
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC USA
| | - Amy L. Miles
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC USA
| | - Steven D. Crowley
- grid.26009.3d0000 0004 1936 7961Department of Medicine, Duke University, Durham, NC USA
| | - Virginia Wang
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Department of Medicine, Duke University, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University, Durham, NC USA
| | - Matthew L. Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Department of Medicine, Duke University, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University, Durham, NC USA
| | - Heather E. Whitson
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Health Care System (VAHCS), Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Center for the Study of Aging and Human Development (the Aging Center), Duke University, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Department of Medicine, Duke University, Durham, NC USA
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Carpenter CR, Southerland LT, Lucey BP, Prusaczyk B. Around the EQUATOR with clinician-scientists transdisciplinary aging research (Clin-STAR) principles: Implementation science challenges and opportunities. J Am Geriatr Soc 2022; 70:3620-3630. [PMID: 36005482 PMCID: PMC10538952 DOI: 10.1111/jgs.17993] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/25/2022] [Accepted: 07/04/2022] [Indexed: 12/24/2022]
Abstract
The Institute of Medicine and the National Institute on Aging increasingly understand that knowledge alone is necessary but insufficient to improve healthcare outcomes. Adapting the behaviors of clinicians, patients, and stakeholders to new standards of evidence-based clinical practice is often significantly delayed. In response, over the past twenty years, Implementation Science has developed as the study of methods and strategies that facilitate the uptake of evidence-based practice into regular use by practitioners and policymakers. One important advance in Implementation Science research was the development of Standards for Reporting Implementation Studies (StaRI), which provided a 27-item checklist for researchers to consistently report essential elements of the implementation and intervention strategies. Using StaRI as a framework, this review discusses specific Implementation Science challenges for research with older adults, provides solutions for those obstacles, and opportunities to improve the value of this evolving approach to reduce the knowledge translation losses that exist between published research and clinical practice.
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Affiliation(s)
- Christopher R Carpenter
- Department of Emergency Medicine and Emergency Care Research Core, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Lauren T Southerland
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Brendan P Lucey
- Department of Neurology, Washington University in St Louis School of Medicine, St. Louis, Missouri, USA
| | - Beth Prusaczyk
- Department of Medicine Institute for Informatics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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Pinho-Gomes AC, Gong J, Harris K, Woodward M, Carcel C. Dementia clinical trials over the past decade: are women fairly represented? BMJ Neurol Open 2022; 4:e000261. [PMID: 36110923 PMCID: PMC9445798 DOI: 10.1136/bmjno-2021-000261] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 08/07/2022] [Indexed: 11/06/2022] Open
Abstract
Background Lack of progress in finding disease-modifying treatments for dementia may be due to heterogeneity in treatment effects among subgroups, such as by sex. Therefore, we investigated the characteristics of dementia trials completed in the last decade, with a focus on women's representation and sex-disaggregated outcomes. Methods Clinical trials on dementia completed since 2010 were identified from ClinicalTrials.gov. Randomised, phase III/IV trials with ≥100 participants were selected to quantify women's representation among participants, by computing the participation to prevalence ratio (PPR) and investigate whether sex-disaggregated analyses had been performed. Results A total of 1351 trials were identified between January 2010 and August 2021 (429 520 participants), of which 118 were eligible for analysis of women's representation and sex-stratified analysis. Only 113 reported the sex of participants and were included in the analysis of women's representation. Of the 110 469 participants in these 113 trials, 58% were women, lower than their estimated representation in the global dementia population of 64%. The mean PPR was 0.90 (95% CI 0.86 to 0.94). Women's participation tended to be higher when the first or last authors of the trial report were women. Eight out of the 118 trials reported sex-disaggregated outcomes, and three of those found significant sex differences in efficacy outcomes. None of the trials reported screening failures or adverse events stratified by sex. Conclusions Overall, women and men were equally represented in dementia trials carried out over the past decade, but women's representation was lower than in the underlying dementia population. Sex-disaggregated efficacy and safety outcomes were rarely reported.
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Affiliation(s)
- Ana-Catarina Pinho-Gomes
- The George Institute for Global Health, Imperial College London, London, UK,Institute for Health Informatics, University College London, London, UK
| | - Jessica Gong
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Mark Woodward
- The George Institute for Global Health, Imperial College London, London, UK,The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Cheryl Carcel
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
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21
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Hunold KM, Goldberg EM, Caterino JM, Hwang U, Platts-Mills TF, Shah MN, Rosen T. Inclusion of older adults in emergency department clinical research: Strategies to achieve a critical goal. Acad Emerg Med 2022; 29:376-383. [PMID: 34582613 PMCID: PMC8958170 DOI: 10.1111/acem.14386] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/13/2022]
Abstract
Medical research across all fields has historically excluded older adults (aged 65 years and older). Because older adults have a higher burden of chronic illness, respond differently to treatment, and are more prone to medication side effects, the results of current research may not be applicable to this important population. To address this major research deficiency, the National Institutes of Health established the Inclusion Across the Lifespan policy, effective January 2019. We present important considerations and proven strategies for successful inclusion of older adults in emergency care research relating to study design, participant recruitment and retention, and sources of support for investigators.
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Affiliation(s)
| | | | | | - Ula Hwang
- Department of Emergency Medicine, Yale School of Medicine, New Haven CT
- Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, NY
| | | | - Manish N. Shah
- BarbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tony Rosen
- Department of Emergency Medicine, Division of Geriatric Emergency Medicine, New York-Presbyterian Hospital / Weill Cornell Medical Center, New York, NY
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22
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Key Recommendations from the 2021 “Inclusion of Older Adults in Clinical Research” Workshop. J Clin Transl Sci 2022; 6:e55. [PMID: 35754432 PMCID: PMC9161040 DOI: 10.1017/cts.2022.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/22/2021] [Accepted: 12/30/2021] [Indexed: 11/07/2022] Open
Abstract
Older adults are often underrepresented in clinical research, even though older adults are major consumers of novel therapies. We present major themes and recommendations from the 2021 "Inclusion of Older Adults in Clinical Research" Workshop, convened by the Clinical and Translational Science Award (CTSA) Inclusion of Older Adults as a Model for Special Populations Workgroup and the Research Centers Collaborative Network (RCCN). The goal of this workshop was to develop strategies to assist the research community in increasing the inclusion of older adults in clinical research. Major identified barriers include historical lack of federal guidelines, ageist biases and stereotypes, and lack of recruitment and retention techniques or infrastructure focused on older adults. Three key recommendations emerged: 1) engaging with the policymaking process to further promote inclusion; 2) using the CTSA Workgroup Presentation Materials Library and other resources to overcome ageism, and 3) building institutional capacity to support age inclusion.
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23
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Liu Q, Schwartz JB, Slattum PW, Lau SWJ, Guinn D, Madabushi R, Burckart G, Califf R, Cerreta F, Cho C, Cook J, Gamerman J, Goldsmith P, van der Graaf PH, Gurwitz JH, Haertter S, Hilmer S, Huang SM, Inouye SK, Kanapuru B, Pirmohamed M, Posner P, Radziszewska B, Keipp Talbot H, Temple R. Roadmap to 2030 for Drug Evaluation in Older Adults. Clin Pharmacol Ther 2021; 112:210-223. [PMID: 34656074 DOI: 10.1002/cpt.2452] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 10/04/2021] [Indexed: 12/17/2022]
Abstract
Changes that accompany older age can alter the pharmacokinetics (PK), pharmacodynamics (PD), and likelihood of adverse effects (AEs) of a drug. However, older adults, especially the oldest or those with multiple chronic health conditions, polypharmacy, or frailty, are often under-represented in clinical trials of new drugs. Deficits in the current conduct of clinical evaluation of drugs for older adults and potential steps to fill those knowledge gaps are presented in this communication. The most important step is to increase clinical trial enrollment of older adults who are representative of the target treatment population. Unnecessary eligibility criteria should be eliminated. Physical and financial barriers to participation should be removed. Incentives could be created for inclusion of older adults. Enrollment goals should be established based on intended treatment indications, prevalence of the condition, and feasibility. Relevant clinical pharmacology data need to be obtained early enough to guide dosing and reduce risk for participation of older adults. Relevant PK and PD data as well as patient-centered outcomes should be measured during trials. Trial data should be analyzed for differences in PK, PD, effectiveness, and safety arising from differences in age or from the presence of conditions common in older adults. Postmarket evaluations with real-world evidence and drug labeling updates throughout the product lifecycle reflecting new knowledge are also needed. A comprehensive plan is needed to ensure adequate evaluation of the safety and effectiveness of drugs in older adults.
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Affiliation(s)
- Qi Liu
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Janice B Schwartz
- Departments of Medicine, Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | - Patricia W Slattum
- Department of Pharmacotherapy and Outcomes Science and Virginia Center on Aging, Virginia Commonwealth University, Richmond, Virginia, USA
| | - S W Johnny Lau
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Daphne Guinn
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Rajanikanth Madabushi
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Gilbert Burckart
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Robert Califf
- Verily and Google Health (Alphabet), South San Francisco, California, USA
| | - Francesca Cerreta
- Portfolio office, European Medicines Agency (EMA), Amsterdam, The Netherlands
| | - Carolyn Cho
- Oncology Early Development and Translational Research, Merck & Co., Kenilworth, New Jersey, USA
| | - Jack Cook
- Department of Clinical Pharmacology, Pfizer Global Research and Development, Groton, Connecticut, USA
| | - Jamie Gamerman
- Office of Medical Policy, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Paul Goldsmith
- Lilly Exploratory Medicine and Pharmacology, Bracknell, UK
| | | | - Jerry H Gurwitz
- Meyers Health Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA
| | - Sebastian Haertter
- Boehringer Ingelheim Pharma, Translational Medicine & Clinical Pharmacology, Ingelheim, Germany
| | - Sarah Hilmer
- Kolling Institute, University of Sydney and Royal North Shore Hospital, St. Leonards, New South Wales, Australia
| | - Shiew-Mei Huang
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Sharon K Inouye
- Marcus Institute for Aging Research, Hebrew SeniorLife and Harvard Medical School, Boston. Massachusetts, USA
| | - Bindu Kanapuru
- Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Munir Pirmohamed
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK
| | - Phil Posner
- Patient-Centered Outcomes Research Institute Ambassador, Gainesville, Florida, USA
| | - Barbara Radziszewska
- National Institute of Aging, National Institute of Health, Bethesda, Maryland, USA
| | - H Keipp Talbot
- Departments of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert Temple
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
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24
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Knowledge Gaps in Health Care Research in Older Adults in Ecuador: Policy Challenges and Opportunities. AGEING INTERNATIONAL 2021. [DOI: 10.1007/s12126-021-09430-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Bowling CB, Lee A, Williamson JD. Blood Pressure Control Among Older Adults With Hypertension: Narrative Review and Introduction of a Framework for Improving Care. Am J Hypertens 2021; 34:258-266. [PMID: 33821943 DOI: 10.1093/ajh/hpab002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/11/2020] [Accepted: 01/08/2021] [Indexed: 01/03/2023] Open
Abstract
Although antihypertensive medications are effective, inexpensive, and recommended by clinical practice guidelines, a large percentage of older adults with hypertension have uncontrolled blood pressure (BP). Improving BP control in this population may require a better understanding of the specific challenges to BP control at older age. In this narrative review, we propose a framework for considering how key steps in BP management occur in the context of aging characterized by heterogeneity in function, multiple co-occurring health conditions, and complex personal and environmental factors. We review existing literature related to 4 necessary steps in hypertension control. These steps include the BP measure which can be affected by the technique, device, and setting in which BP is measured. Ensuring proper technique can be challenging in routine care. The plan includes setting BP treatment goals. Lower BP goals may be appropriate for many older adults. However, plans must take into account the generalizability of existing evidence, as well as patient and family's health goals. Treatment includes the management strategy, the expected benefits, and potential risks of treatment. Treatment intensification is commonly needed and can contribute to polypharmacy in older adults. Lastly, monitor refers to the need for ongoing follow-up to support a patient's ability to sustain BP control over time. Sustained BP control has been shown to be associated with a lower rate of cardiovascular disease and multimorbidity progression. Implementation of current guidelines in populations of older adults may be improved when specific challenges to BP measurement, planning, treating, and monitoring are addressed.
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Affiliation(s)
- C Barrett Bowling
- U.S. Department of Veterans Affairs, Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), Durham, North Carolina, USA
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Alexandra Lee
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Jeff D Williamson
- Department of Internal Medicine, Section on Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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26
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Krishnaswami A, Beavers C, Dorsch MP, Dodson JA, Masterson Creber R, Kitsiou S, Goyal P, Maurer MS, Wenger NK, Croy DS, Alexander KP, Batsis JA, Turakhia MP, Forman DE, Bernacki GM, Kirkpatrick JN, Orr NM, Peterson ED, Rich MW, Freeman AM, Bhavnani SP. Gerotechnology for Older Adults With Cardiovascular Diseases: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 76:2650-2670. [PMID: 33243384 PMCID: PMC10436190 DOI: 10.1016/j.jacc.2020.09.606] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/18/2020] [Accepted: 09/21/2020] [Indexed: 12/19/2022]
Abstract
The growing population of older adults (age ≥65 years) is expected to lead to higher rates of cardiovascular disease. The expansion of digital health (encompassing telehealth, telemedicine, mobile health, and remote patient monitoring), Internet access, and cellular technologies provides an opportunity to enhance patient care and improve health outcomes-opportunities that are particularly relevant during the current coronavirus disease-2019 pandemic. Insufficient dexterity, visual impairment, and cognitive dysfunction, found commonly in older adults should be taken into consideration in the development and utilization of existing technologies. If not implemented strategically and appropriately, these can lead to inequities propagating digital divides among older adults, across disease severities and socioeconomic distributions. A systematic approach, therefore, is needed to study and implement digital health strategies in older adults. This review will focus on current knowledge of the benefits, barriers, and use of digital health in older adults for cardiovascular disease management.
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Affiliation(s)
- Ashok Krishnaswami
- Division of Cardiology, Kaiser Permanente Medical Center, San Jose, California.
| | - Craig Beavers
- Division of Pharmacy, University of Kentucky, Lexington, Kentucky
| | - Michael P Dorsch
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan
| | - John A Dodson
- NYU Langone Health, NYU Grossman School of Medicine, New York, New York
| | - Ruth Masterson Creber
- Weill Cornell Medicine, Department of Population Health Sciences, Division of Health Informatics, New York, New York
| | - Spyros Kitsiou
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | | | - Karen P Alexander
- Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - John A Batsis
- Department of Medicine, Geisel School of Medicine and The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College and Dartmouth-Hitchcock, Lebanon, New Hampshire; Division of Geriatric Medicine, School of Medicine, Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Chapel Hill, North Carolina
| | - Mintu P Turakhia
- Center for Digital Health, Stanford University, Stanford, California; Palo Alto Veterans Administration Health Care System, Palo Alto, California
| | - Daniel E Forman
- Division of Geriatric Cardiology, University of Pittsburgh, Geriatric Research, Education and Clinical Center; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Gwen M Bernacki
- Cardiovascular Division, Department of Medicine, Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington
| | - James N Kirkpatrick
- Cardiovascular Division, Department of Medicine, Department of Bioethics and Humanities, University of Washington, Seattle, Washington
| | - Nicole M Orr
- Post-Acute Cardiology Care, LCC, Darien, Connecticut; Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
| | - Eric D Peterson
- Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Michael W Rich
- Cardiovascular Division, Washington University, St. Louis, Missouri
| | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Sanjeev P Bhavnani
- Prebys Cardiovascular Institute, Scripps Clinic & Research Foundation, San Diego, California
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27
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Linnebur S. New NIH Research Policy Seeks Greater “Inclusion Across Lifespan”; AGS Editorial Explains How…And Why. Geriatr Nurs 2019. [DOI: 10.1016/j.gerinurse.2019.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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28
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Kuchel GA. Inclusion of Older Adults in Research: Ensuring Relevance, Feasibility, and Rigor. J Am Geriatr Soc 2019; 67:203-204. [PMID: 30693942 DOI: 10.1111/jgs.15802] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/25/2022]
Affiliation(s)
- George A Kuchel
- University of Connecticut Health Center - UCONN Center on Aging, Farmington, Connecticut
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