2024 theme: “Prevention: The Path to Healthier, Longer Lives”
In mid-November at the 7th annual Longevity Week, a multi-faceted series of discussions on health, science, technology and financial investment presented by The Longevity Forum in the UK, I attended an interesting on-line session, a small gathering hosted by a special interest group of the British Society of Gerontology (BSG) titled “Underrepresentation of Older People in Clinical Trials”. Interesting as a prelude to the next day’s feature on longevity and biotechnologies.
The BSG special interest group Ageing, Business, and Society focused on the insight that: “despite the growing number of older individuals in our population, their representation in clinical research remains disproportionately low”. This seemed startling; and as an aside, working as a career consultant over 20 years ago, one of my first clients was a clinical trial researcher in the pharmaceutical industry who educated me on what the work in that occupation involved.
So naturally, this session resonated with me and the five panelists including Dr. Declan Doogan, a Co-founder of Juvenescence (more later in part 3) really made the case that it is a major fault not to involve those in their 60’s, 70’s and older in the clinical trial process, though there are obstacles, such as bias based on setting arbitrary age limits, and simply in some cases, mobility – providing and paying for transportation to get people to the location where trials were conducted.
One of the refreshing voices on this panel was Hannah Thomson, Founder CEO, Joy Club, recently acquired and renamed Rest Less – an online digital community for older adults 50+ with over one million members in the UK. Previously, Joy Club conducted a limited survey of its members 60’s and 70’s to measure the interest level and/or participation in clinical trials.
In this survey sample, of those who attempted to engage in these trials, just over 50 percent were accepted and those not were either ignored, the location site was inconvenient or they didn’t match the trial criteria. However when those accepted were asked if they would participate again, 78 percent said yes, with remarks such as that they saw it as their civic duty or that they saw it as a help to future generations, even though there were concerns over their privacy and safety.
Many other considerations were discussed relating to broadening of the representation of older people in clinical trials. Dr. Emma Harvey, Vice President, Faculty of Pharmaceutical Medicine referenced a great article from 2022 in the academic journal Age and Ageing titled Clinical trials in older people where it states in its introduction:
“Clinical trials, especially randomised controlled trials (RCTs), provide the best evidence to guide decision making in healthcare….In geriatrics, RCTs have long been used to test the effectiveness of geriatric care models….Though comprehensive management models were tested in rigorous trials, older patients (75+) were generally excluded from medication trials until recent years.”
If geriatric care is to help improve healthier longevity, does it not make sense to be more inclusive by broadening the age range? Jeremy Taylor OBE, Director for Public Voice, National Institute for Health and Care Research thinks so, and he added that diversity in representation in research needs not only to reflect a broader range in age, but gender, ethic culture, and in the etc. column, socioeconomic status.
In closing, paraphrasing one of Taylor’s poignant comments, in addition to sound scientific reasons is there not a moral case for being more inclusiveness in clinical trials? If it’s a desirable moral issue to have better representation of older people in clinical trials, then the closing question came down to: how should we move to include them more – legislation, multi stakeholder incentives, or even more creative, how about setting a control group that follows people all through their life span?
“In the USA, major gaps in clinical trial participation during new drug evaluation include: insufficient enrollment of (1) those aged 75 years and older, especially those older than 80 years, (2) those with multimorbidity (ie, more than 3 chronic conditions), (3) those receiving polypharmacy (ie, three or more regular medications), and (4) those with a state of increased vulnerability across multiple health domains that leads to adverse health outcomes.”
