The 5Ts: Preliminary Development of a Framework to Support Inclusion of Older Adults in Research

Abstract

Background/Objectives To address the underrepresentation of older adults in clinical research, the National Institutes of Health will require investigators to include individuals across the lifespan. As investigators from other fields endeavor to recruit participants who are more representative of the patient population, geriatricians may have the opportunity to influence a broad range of research studies in older adults. Our aims were to elicit challenges to inclusion of older adults in clinical research and to develop a preliminary framework for communicating these challenges to non–geriatrics‐trained researchers. Design Communication framework development. Setting Academic hospital and Veterans Affairs Medical Center. Participants Nongeriatrician researchers and staff, aging research experts. Measurements Interviews were used to elicit challenges nongeriatrician investigators and research staff experience when conducting research that includes older adults and then solicit experienced aging researchers' responses to these challenges. Results Challenges described by nongeriatrician investigators included lack of knowledge, rigid study structures, and a disease‐focused approach. Responses from our geriatrics experts included communicating practical advice for avoiding common pitfalls. Our resulting framework is the 5Ts: Target Population, Team, Tools, Time, and Tips to Accommodate. This tool complements the 5Ms (Mind, Mobility, Medications, Multicomplexity, and Matters Most to Me) model for geriatric care and emphasizes representation of the Target Population, building research Teams that include aging expertise, incorporating appropriate Tools for function and patient‐reported outcomes, anticipating Time for longer study visits, and accommodating common needs with practical Tips. Limitations include convenience sampling and lack of formal qualitative thematic analysis. Conclusion Communicating with nongeriatrician researchers using the 5Ts may offer a practical approach to avoiding barriers to inclusion of older adults in research and complements an existing framework for communicating the value of geriatric medicine. Next steps in developing the 5Ts will be to include additional stakeholders (eg, national samples of nongeriatrician investigators, older adults and their families) and evaluating the impact of its implementation. J Am Geriatr Soc 67:342–346, 2019.

Spotlight on Older Adults in Swallowing Research

“…A single site study from 2007 to 2014 observed a 222% increase in acute dysphagia referrals for hospitalised patients 90 years and older [24]. Participant recruitment requires careful planning to ensure the oldest old are represented in countries with ageing populations, such as applying the 5Ts framework [19]. A recent systematic review on the effects of age on swallowing identified only one third of published studies (38/107) recruited adults over 85 years old [8].…”

“…Underrepresentation of very old adults can also limit the clinical application of research findings. The 5Ts framework (target population, team, tools, time, and tips) was recently developed to address barriers to recruitment of older adults in clinical research and provide a strategy for inclusion [19]. This framework complements the 5Ms (mind, mobility, medications, multicomplexity, and matters most to me) which promotes the key competencies of geriatrics in clinical practice [20].…”

Inclusion of Older Adults in Research: Ensuring Relevance, Feasibility, and Rigor

“…All of these issues, together with best practice strategies to overcome obstacles to the recruitment and retention of older adults in aging research, were discussed in the December 2008 issue of this journal . A decade later, it is gratifying to see three articles address the inclusion of older adults in research . Timing is perfect given major progress at the national level in the form of a new NIH (National Institutes of Health) policy effective as of January 25 2019 mandating the inclusion of older adults into all NIH‐supported research involving human subjects when scientifically appropriate.…”

“…The posting by NIA of a funding opportunity announcement for applications related to the science of examining diversity, recruitment, and retention in aging research should greatly accelerate progress . Also, the 5Ts Framework described by Bowling et al in this issue provides practical insights into addressing some of the barriers to participation by non‐geriatrician investigators and research staff without experience in aging research and may also help frame future research on this topic.…”

“…With all of the considerations just described in mind, it is quite likely that in another decade we will once again reflect on yet further additional progress and the importance of the issues regarding recruitment of older adults in aging research as highlighted in these three publications …”