Intended for healthcare professionals

Rapid response to:


Including older people in clinical research

BMJ 2005; 331 doi: (Published 03 November 2005) Cite this as: BMJ 2005;331:1036

Rapid Response:

Including the Very Old in Clinical Research

McMurdo et al [1] have again highlighted the ageism that continues to
exist in research. We agree with the points that they raise. It is
important to remember that in relation to older people it is the number of
very old (aged 80 or more) that are increasing the fastest. In the
European Union (25 countries) over the next 45 years the number that will
fall into to this age bracket will increase from 4% to 11.4%, in real
terms an increase of 33 million people. [2] Patients in this group are
more often excluded or not recruited to clinical trials for the reasons
alluded to by the authors.

We are currently running an international trial specifically in those
aged 80 or more (the Hypertension in the Very Elderly Trial, HYVET) and to
date have randomised in excess of 2,800 patients. [3] The mean age of
patients at entry to the trial is 83.8 ± 3.3 years (range 80-100). Our
local investigators have experienced all the problems mentioned by the
authors with regards to recruitment. However, our experience is that these
problems can be partially surmounted. Following up patients at home,
developing collaborative links with general practitioners, using GP based
rather than hospital based local investigators to allow closer links with
patient has all helped. In HYVET patients have been recruited in northern
Finland despite temperatures well below freezing in the winter months. In
New Zealand an audit of several GP practices and the involvement of nurses
based in the practices has proved successful. [4] In another country an
investigator even hired a minibus and drove 6 of his patients more than
30km for CT scans as part of an assessment for cognitive decline. For one
patient it was the first time she had been out of her village for 80

1.McMurdo M, Witham M, Gillespie Including older people in clinical
research BMJ 2005: 331: 1036-7

2.Eurostat News Release 8 April 2005.

3. Bulpitt C, Fletcher A, Beckett N, et al The hypertension in the very
elderly trial (HYVET): protocol for the main trail. Drugs and Ageing 2001;
18: 151-164

4. Senior H, Anderson C, Chen M et al Management of hypertension in the
oldest old: a study in primary care in New Zealand Age and Ageing (in

Competing interests:
The HYVET trial is funded by the Institute de Recherches Internationales Servier

Competing interests: No competing interests

05 December 2005
Nigel S Beckett
Clinical Research Fellow/ Honorary Consultant Physician
Ruth Peters, Christopher Bulpitt
Imperial College London, Section of Care of the Elderly (Hammersmith Campus), London W12 0NN