Challenges in clinical aging research: building the evidence base for care of the older adult.
Challenges in clinical aging research: building the evidence base for care of the older adult.
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临床衰老研究的挑战：建立老年人护理的证据基础。
DOI：
10.1111/j.1532-5415.2008.02028.x
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发表时间：
2008
影响因子：
6.3
通讯作者：
Studenski,Stephanie
中科院分区：
文献类型：
--
作者：
Studenski,Stephanie
根据Mody等人在本期JAGS上发表的文章，1我们发起了一个重要的新系列临床衰老研究方法。老年人更有可能患有多种疾病，服用更多药物，接受更多手术，并使用比任何其他年龄组更多的医疗保健，但老年人护理的证据基础通常来自年轻人的研究，不太复杂的人群。4-8证据与其应用人群之间的这种差异可归因于临床研究方法中的许多概念和实用挑战。老年医学领域内外的临床研究人员已经开发出新的方法和创造性的策略来克服这些挑战，但这些解决方案往往没有在研究手稿中明确提出，也没有广为人知。美国老年医学会（AGS）和美国老年医学会杂志（JAGS）的核心使命之一是促进老年人的循证护理，从而提高生活质量和功能独立性。9因此，我们有责任传播有助于产生证据的知识，这一新的研究系列的目标是研究临床研究方法如何为增加老年人护理的证据基础创造障碍，并描述基于新的和新兴的研究概念和实践的周到应用的解决方案。传统上，严格研究和证据的标准旨在阐明孤立疾病的原因和治疗方法。这些传统的设计假设在老化中不起作用，需要替代方法。10随着慢性疾病的积累和与衰老的相互作用，研究问题的重点发生了变化;医疗保健研究必须纳入新的范式，以了解疾病的潜在因素，11多系统问题，如老年综合征，12以及功能和生活质量等结果的重要性。13-15临床研究者在老龄化领域开发的新概念和方法允许研究更广泛和更相关的研究问题，并增加了管理将老年人纳入研究的复杂性的方法库。我们希望本系列文章对医疗保健提供者、调查人员、卫生专业培训人员、提案审查人员、资助赞助商和政策制定者有用，他们都依赖于证据的创建和使用，为老年人提供最佳护理。
With the article in this issue of JAGS by Mody et al., 1 we initiate an important new series on clinical aging research methods. Older adults are more likely to suffer from multiple diseases, take more medications, undergo more procedures, and use more health care than any other age group, 2, 3 yet the evidence base for care of the older adult is frequently derived from studies of younger, less complex populations. 4–8 This discrepancy between the evidence and the population to which it is applied can be attributed to numerous conceptual and pragmatic challenges in clinical research methodology. Clinical investigators within and beyond the field of geriatrics have developed new approaches and creative strategies to overcome such challenges, but these solutions are often not explicitly presented in research manuscripts and are not widely known. One of the core missions of the American Geriatrics Society (AGS) and the Journal of the American Geriatrics Society (JAGS) is to promote evidence based care for older adults that results in better quality of life and functional independence. 9 Thus, it is incumbent on us to disseminate knowledge that will help to generate that evidence.The goal of this new research series is to examine the ways that clinical research methodologies create barriers to increasing the evidence base for care of the older adult and to describe solutions based on thoughtful application of new and emerging research concepts and practices. Traditionally, the standards for rigorous research and evidence were designed to elucidate the causes and treatment of isolated diseases. These traditional design assumptions do not work well in aging, and alternative approaches are needed. 10 The focus of the research question changes as chronic illnesses accumulate and interact with aging; healthcare research must incorporate new paradigms to understand the underlying contributors to disease, 11 multisystem problems such as geriatric syndromes, 12 and the importance of outcomes such as function and quality of life. 13–15 The new concepts and approaches developed by clinical investigators in the field of aging permit study of this broader and more-relevant range of research questions and increase the repertoire of methods to manage the complexity of including older adults in research. We hope that the articles in this series will be useful to healthcare providers, investigators, health professions trainees, proposal reviewers, grant sponsors, and policy makers, all of whom depend on the creation and use of evidence to provide the best care to older adults.