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Why do older adults decline participation in research? Results from two deprescribing clinical trials

Thomas E Strayer1,2, Emily K Hollingsworth3,4, Avantika S Shah3,5

  • 1Center for Quality Aging, Vanderbilt University Medical Center, 2147 Belcourt Ave., Nashville, TN, 37212, USA. thomas.e.strayer@vumc.org.

Trials
|July 18, 2023
PubMed
Abstract

Insights

Older adults often decline deprescribing trials due to feeling overwhelmed, mistrust in research, or hesitancy about deprescribing. Understanding these barriers is key to improving clinical trial diversity in older populations.

Area of Science:

  • Gerontology
  • Clinical Trials
  • Pharmacology

Background:

  • Older adults are underrepresented in clinical trials.
  • Their participation is crucial for developing targeted interventions.
  • Hospitalized older adults' reasons for declining deprescribing trials were evaluated.

Purpose of the Study:

  • To identify and analyze the reasons why hospitalized older adults declined participation in two deprescribing clinical trials.
  • To understand barriers to research participation in this demographic.

Main Methods:

  • Enrollment data from two deprescribing trials (Shed-MEDS and VA DROP) were analyzed.
  • Inclusion criteria: hospitalized, age 50+, English-speaking, 5+ home medications.
  • Reasons for declining were inductively themed and compared between Veterans and non-Veterans using chi-square tests.

Main Results:

  • 1226 patients declined enrollment, providing reasons condensed into three themes: feeling overwhelmed, lack of interest/mistrust in research, and deprescribing hesitancy.
  • Veterans were more likely to express mistrust (42% vs 26%), while non-Veterans were more likely to feel overwhelmed (54% vs 35%).
  • Hesitancy towards deprescribing showed no significant difference between groups (23% vs 21%).

Conclusions:

  • Key barriers to trial participation for older adults include health status, research mistrust, and deprescribing concerns.
  • Findings can inform strategies to enhance engagement of multimorbid older adults in clinical research.
  • Addressing these specific reasons may improve recruitment and trial diversity.
Keywords:
DeprescribingPatient engagementPolypharmacy

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