Making General Internal Medicine Research Relevant to the Older Patient with Multiple Chronic Comorbidities
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General Internal Medicine research evolves in response to the needs of the patients to whom we provide care. Currently, many studies exclude older adults who deeply affect the clinical care of this population. With the number of older adults increasing, creating research protocols that include older adults with multiple chronic comorbidities is imperative. Through funding from the Association of Specialty Physicians, a working group of aging-responsive researchers from the Society of General Internal Medicine was convened to tackle this issue. The goal of this article is threefold: 1) to shed light on the current exclusion of older adults in research; 2) to identify and propose research protocol solutions for overcoming barriers to including older adults in research; and 3) to provide suggestions for research funding. The extent to which these recommendations can create change depends greatly on our researcher colleagues. By embracing these challenges, we hope that the care provided to older adults with multiple chronic conditions will no longer be extrapolated, but become evidence-based.
- McMurdo MET, Witham MD, Gillespie ND. Including older people in clinical research—benefits shown in trials in younger people may not apply to older people. Br Med J. 2005;331(7524):1036–7. CrossRef
- Zulman DM, Sussman JB, Chen X, Cigolle CT, Blaum CS, Hayward RA. Examining the evidence: a systematic review of the inclusion and analysis of older adults in randomized controlled trials. J Gen Intern Med. 2011;26(7):783–90. CrossRef
- Van Spall HGC, Torn A, Kiss A, Fowler RA. Eligibility criteria of randomized controlled trials published in high-impact general medical journals—a systematic sampling review. JAMA. 2007;297(11):1233–40. CrossRef
- Agency for Healthcare Research and Quality. AHRQ Policy on the Inclusion of Priority Populations in Research. US Department of Health and Human Services; 2003.
- US Government Accountability Office. Prescription drugs: FDA guidance and regulations related to data on elderly persons in clinical drug trials (GAO-07-47R). Washington, D.C.; 2007.
- Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB Jr, Walston JD. Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc. 2004;52(4):625–34. CrossRef
- Luck T, Luppa M, Briel S, Matschinger H, König HH, Bleich S, Villringer A, Angermeyer MC, Riedel-Heller SG. Mild cognitive impairment: incidence and risk factors results of the leipzig longitudinal study of the aged. J Am Geriatr Soc. 2010;58(10):1903–10. CrossRef
- Karlawish J. Measuring decision-making capacity in cognitively impaired individuals. Neurosignals. 2008;16(1):91–8. CrossRef
- U.S. Department of Health & Human Services; Code of Federal Regulations, Title 45 – Public Welfare, Part 46 – Protection of Human Subjects. 45 CFR 46.116. Available at: http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.html. (Accessed Sept. 27, 2013).
- Health and Retirement Study: Sample sizes and response rates. Available at: http://hrsonline.isr.umich.edu/sitedocs/sampleresponse.pdf. (Accessed Sept. 27, 2013).
- Emanuel EJ, Menikoff J. Reforming the regulations governing research with human subjects. NEJM. 2011;365(12):1145–50. CrossRef
- Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55(5):780–91. CrossRef
- Tinetti ME, McAvay GJ, Murphy TE, Gross CP, Lin H, Allore HG. Contribution of individual diseases to death in older adults with multiple diseases. J Am Geriatr Soc. 2012;60(8):1448–56. CrossRef
- Tinetti ME, McAvay GJ, Chang SS, Newman AB, Fitzpatrick AL, Fried TR, Peduzzi PN. Contribution of multiple chronic conditions to universal health outcomes. J Am Geriatr Soc. 2011;59(9):1686–91. CrossRef
- Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The Mini-Cog: a cognitive “vital sign” measure for dementia screening in multi-lingual eldelr. Int J Geriatr Psychiatry. 2000;15(11):1021–7. CrossRef
- Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc. 1975;23(10):433–41.
- Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695–9. Available at http://www.mocatest.org/ (accessed Sept.27, 2013). CrossRef
- Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of ADL. Gerontologist. 1970;10:20–30. CrossRef
- Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–86. CrossRef
- Karnofsky DA, Burchenal JH. The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM, ed. Evaluation of Chemotherapeutic Agents. Columbia Univ Press; 1949. P.196.
- Chang VT, Hwang SS, Kasimis B, et al. Shorter symptom assessment instruments: the Condensed Memorial Symptom Assessment Scale (CMSAS). Cancer Investig. 2004;22:526–36. CrossRef
- Podsiadlo D, Richardson S. The timed ‘Up & Go’: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142–8.
- Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113(12):941–8. CrossRef
- Kroenke K, Spitzer RL, Williams JB. The PHQ-9 validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13. CrossRef
- Sheikh JI, Yesavage JA. Geriatric depression scale: recent evidence and development of a shorter version. Clin Gerontol. 1986;5:165–72. CrossRef
- Lachs MS, Feinstein AR, Cooney LM Jr, Drickamer MA, Marottoli RA, Pannill FC, Tinetti ME. A simple procedure for general screening for functional disability in elderly patients. Ann Intern Med. 1990;112(9):699–706. CrossRef
- Working Group on Health Outcomes for Older Persons with Multiple Chronic Conditions. Universal health outcome measures for older persons with multiple chronic conditions. J Am Geriatr Soc. 2012;60(12):2333–41. CrossRef
- Making General Internal Medicine Research Relevant to the Older Patient with Multiple Chronic Comorbidities
Journal of General Internal Medicine
Volume 29, Issue 6 , pp 915-919
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- 1. Division of Geriatrics and General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- 2. Division of Geriatrics, University of California San Francisco School of Medicine, San Francisco, CA, USA
- 3. Division of General Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
- 4. VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
- 5. Division of Clinical Pharmacology and Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- 6. Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA