ABSTRACT
The National Council on Aging's Building Better Caregivers program aims to improve the well-being of caregivers of veterans.
ABSTRACT
BACKGROUND: The incidence of HIV and AIDS is growing faster among individuals 50 and older compared to those under 40. Although the majority of clinical trials aimed at treating diseases have been found to exclude older individuals, it is not yet known whether this bias extends to sexually transmitted disease (STD) risk-reduction clinical trials published in a wide range of journals. METHODS: We conducted a systematic review of STD risk-reduction clinical trials that were published in the English-language journals included in MEDLINE between January 1, 1994, and January 1, 2005. RESULTS: Over two-thirds (73%) of these clinical trials excluded persons over the age of 50 and 89% excluded persons over the age of 65. The level of inclusion of these older individuals showed no improvement during the 10 years of the systematic review. CONCLUSIONS: The pattern of excluding individuals above the age of 50 from STD risk-reduction clinical trials has persisted even though AIDS is increasing most rapidly in this age group. Therefore, a need exists to increase older individuals' representation in these clinical trials.
Subject(s)
Aged , Clinical Trials as Topic/standards , Middle Aged , Patient Selection , Prejudice , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/prevention & control , Adult , Age Distribution , Age Factors , Clinical Trials as Topic/statistics & numerical data , Female , HIV Infections/epidemiology , HIV Infections/etiology , HIV Infections/prevention & control , Health Services for the Aged , Humans , Male , Patient Selection/ethics , Risk Factors , Selection Bias , Sexually Transmitted Diseases/etiologyABSTRACT
BACKGROUND: It has been found that the elderly population is underrepresented in clinical trials aimed at disease treatment. It is unknown to what extent this group is also excluded from clinical trials aimed at reducing health-risk behaviors. METHOD: We systematically reviewed clinical trials targeting the leading health-risk behaviors, as identified by Healthy People 2010: tobacco use, overweight/obesity, physical inactivity, substance abuse, and irresponsible sexual behavior. Using MEDLINE, we identified clinical trials published in the five most cited medical journals between January 1990 and May 2004. RESULTS: The majority (53%) of the 198 health-risk behavior clinical trials excluded persons over the age of 65; the exclusion percentage increased to 72% for those over the age of 75. The exclusion of elderly persons in these five medical journals did not decline over the 14 years studied. This age exclusion pattern was not explained by the intervention's intrusiveness or whether illness was an exclusion criterion. The trials that included those over the age of 65 were more likely to report a significant finding in the predicted direction. CONCLUSIONS: Although elderly persons are most at risk for diseases linked to lifestyle behavior, such as heart disease, they were excluded from the majority of health-risk behavior clinical trials in five major medical journals.
