Intended for healthcare professionals


Including elderly people in clinical trials

BMJ 1997; 315 doi: (Published 25 October 1997) Cite this as: BMJ 1997;315:1033

Better information could improve the effectiveness and safety of drug use

  1. Jerry Avorn, Associate professor of medicinea
  1. a Harvard Medical School, Boston, MA 02115, USA

    Practitioners face a difficult paradox in prescribing for the elderly. Those aged over 65 comprise only about 14% of the population in most industrialised countries, yet they consume nearly a third of all drugs. Ample evidence indicates that, even in healthy elderly people, aging impairs the way the body handles drugs. In ill elderly people these changes can be exaggerated considerably.1

    In an ideal world data from premarketing and postmarketing surveillance studies would describe how a given drug is likely to affect older patients differently from younger ones.2 Unfortunately, rather than being oversampled in clinical trials, to reflect their distribution in the drug consuming population, elderly people are inadequately represented.3 4 Moreover, when “old” patients are enrolled in trials, they are likely to be in their mid-60s and in quite good health. Nevertheless, we do not know to what extent “the elderly” …

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