Advancing the relevance of clinical trials for older patients

Older patients represent the fastest growing patient group in clinical care. They are a heterogeneous group, for whom evidence for making treatment decisions is often scarce. Important domains for advancing the relevance of clinical trials for older patients are selection and inclusion of representative patients, choosing appropriate therapeutic interventions, and studying relevant outcomes. In the last decade, a myriad of publications has recommended multiple solutions that improve the relevance of trials for older people. Although uptake of these recommendations has been slow, there are now some excellent and successful implementation approaches that show that it is possible to design and execute trials that are inclusive of older patients, address relevant outcomes, and allow for real-world comparisons of intervention effectiveness. Observational studies based on different data sources add useful complementary information. This narrative review aims to synthesise best practices and successful strategies to improve the relevance of clinical trials for older patients.