Elderly Excluded From Drug Trials

BBC News

February 1, 2010

United Kingdom

Geriatricians want drugs to be tested more often on older people

The EU funded project, called PREDICT, says treatments are less likely to be tested on older people even though the elderly take the most medication. 

Trial results from younger people cannot always be extrapolated to the elderly, say the authors. 

They want older people to have access to drugs which have been shown to be safe and effective for their age group. 

PREDICT set out assess the extent to which the elderly were excluded from clinical trials and to come up with solutions. 

They surveyed the medical literature on treatments for conditions which were common among elderly people and found clear evidence that the elderly were underrepresented. 

For example, the average age of patients in clinical trials of treatments for high blood pressure is 63, although 44% of patients are over 70 when they are first diagnosed. 

“The elderly are underrepresented in clinical trials because of ageism ” 
Stephen Jackson, Professor of Professor of Clinical Gerontology from King's College London. 

The researchers interviewed health professionals in nine countries and conducted more than 50 focus groups with elderly people and their carers. 

They concluded that both doctors and patients felt that more elderly people should be included in trials. 

"If treatments are not evaluated for elderly people it is difficult for doctors to balance the risks and benefits" said Dr Gary Mills, Director of Medical 

Economics and Research Centre, Sheffield, who is one of the co-ordinators of the project. 

'Practical steps' 

Dr Mills said people conducting trials may need to take practical steps to help the elderly participate, such as going to their house rather than expecting them to travel. 

The British Geriatrics Society welcomed the project. Their spokesman Professor David Oliver said the under-representation of elderly people in clinical trials was a "serious problem". 

He said it was easier for drug companies to carry out testing on younger people, but this means the trial group is "not representative" of the majority of taking medicines. 

He added that drugs might be more or less effective on the elderly than younger older people, and might have different side effects. 

"Doctors try to practise evidence-based medicine, but this is not possible if there are not enough elderly people in the trials." 

'Ageism' 

Stephen Jackson, Professor of Professor of Clinical Gerontology from King's College, London, said the reasons why not enough elderly people are included in trails go beyond practical difficulties. 

"The elderly are underrepresented in clinical trials because of ageism," he said. 

He pointed out that elderly people often have more than one condition and that makes it more complicated for those conducting trials to include them. 

People conducting trials think it is "too much trouble" to include older people he said. This would not change without regulation, he added. 

Age Concern welcomed the initiative. Andrew Harrop their Head of Policy said: "More and more people will be living longer and many with multiple long-term conditions. 

"Addressing the shortfall in the numbers of older people taking part in clinical trials is crucial to ensure the well-being of a growing proportion of the population."   

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