Disparate Inclusion of Older Adults in Clinical Trials: Priorities and Opportunities for Policy and Practice Change
Disparate Inclusion of Older Adults in Clinical Trials: Priorities and Opportunities for Policy and Practice Change
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DOI：
10.2105/ajph.2009.162982
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发表时间：
2010-01-01
影响因子：
12.7
通讯作者：
Weinberg, Armin D.
中科院分区：
文献类型：
--
作者：
Herrera, Angelica P.;Snipes, Shedra Amy;Weinberg, Armin D.
尽管老年人承担着不成比例的疾病负担以及处方药和疗法的消耗，但在临床试验中的代表性严重不足，限制了治疗的普遍性、有效性和安全性。消除临床试验中的差异是一项全国性倡议，由研究人员、社区倡导者、政策制定者和联邦代表组成的利益相关者网络组成，对老年人参与临床试验的结构性障碍进行了批判性分析。我们提出了从这一过程中产生的实践和政策变革建议及其基本原理，这些建议涵盖多个主题：（1）认知障碍患者的决策； (2)药代动力学差异和生理年龄； (3) 健康素养、沟通和老龄化； (4)老年医学培训； (5) 联邦监督和问责； （六）临床试验费用； (7) 老龄化和种族的累积效应。 （美国公共卫生杂志。2010；100：S105-S112。doi：10.2105/AJPH.2009.162982）
Older adults are vastly underrepresented in clinical trials in spite of shouldering a disproportionate burden of disease and consumption of prescription drugs and therapies, restricting treatments' generalizability, efficacy, and safety. Eliminating Disparities in Clinical Trials, a national initiative comprising a stake-holder network of researchers, community advocates, policymakers, and federal representatives, undertook a critical analysis of older adults' structural barriers to clinical trial participation. We present practice and policy change recommendations emerging from this process and their rationale, which spanned multiple themes: (1) decision making with cognitively impaired patients; (2) pharmacokinetic differences and physiological age; (3) health literacy, communication, and aging; (4) geriatric training; (5) federal monitoring and accountability; (6) clinical trial costs; and (7) cumulative effects of aging and ethnicity. (Am J Public Health. 2010;100:S105-S112. doi:10.2105/AJPH.2009.162982)