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Clinical research must include more older people

BMJ 2013; 346 doi: (Published 21 June 2013) Cite this as: BMJ 2013;346:f3899
  1. Marion McMurdo, professor, ageing and health, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
  1. m.e.t.mcmurdo{at}

Why are the people who take part in clinical research systematically different from those seen in practice? Marion McMurdo says funders, ethics committees, and journals must stop older people being under-represented

If recruitment to heart failure trials is a valid measure of how well the research community has progressed in embracing the participation of older people in research, then the cause may be all but lost.

Recent analysis of the World Health Organization International Clinical Trials Registry showed that of 251 trials investigating heart failure treatments, a quarter excluded patients via an upper age limit, and 43% had at least one poorly justified exclusion criterion.1

An analysis of a large cohort of Medicare beneficiaries with heart failure—disease in which 80% of patients are older than 65 years old—reported that only a paltry 18%, 13%, and 25% of those over 65 met the enrolment criteria for the landmark SOLVD, MERIT-HF, and RALES trials. The analysis proposed convenience and study efficiency as possible reasons.2

We have known for years that older people are systematically …

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