Most clinical trials are conducted in patients aged 18 to 64 years. Historically, older adults aged 65+ have been underrepresented. As a result, although over-65s are the fastest-growing proportion of the population worldwide, we lack significant information on the safety and efficacy of treatments for older patients.
New NIH policy guidelines require all grant applications to detail how they intend to include people of all ages in their research from January 25th 2019, but more needs to be done to tackle this underrepresentation in both private and publicly funded research.
A key misconception we frequently hear about at Longboat is that older patients consider the increasing use of technology in trials a barrier to participation, and will not engage with digital technologies. Evidence shows that this is simply not the case. In fact, as older adults become more digitally savvy, technology could hold the key to better engagement of this group.
Technology Is an Enabler, Not a Barrier
A recent survey from the American Association of Retired Persons found that over 90% of adults over 50 own a computer or laptop, 70% have a smartphone, and over 40% own a tablet. Most over 50s use their computers for banking, purchases, surfing the internet, or reading news, and use their mobile phones mostly for sending and receiving messages or getting directions. They are frequent users too. Roughly three-quarters of older internet users go online at least daily, including 17% who say they go online about once a day, 51% who indicate they do so several times a day, and 8% who say they use the internet almost constantly. Amongst older adults who own smartphones, this figure is even higher: 76% use the internet several times a day or more.
A small but notable minority of older adults are now using their device to manage their medical care, and it works. It's estimated that medication management technology increases adherence by 40%, potentially saving 50,000 lives and $120 billion each year.
Considerations for Using Technology to Engage Older Patients
Despite this willingness to learn, it remains the case that older adults face unique barriers to using and adopting new technologies. For example, for those in their 80s, the screen size and how much manual dexterity a device needs becomes increasingly important. To meet the needs of older adults as a group, technologies must be designed with intuitive features and straightforward navigation to minimize confusion and avoid mistakes. This infographic created by University of Southern California provides some invaluable recommendations about technology features that can help older adults.
Interestingly, other research by Lancaster University has shown that older adults themselves are often the worst perpetuators of the myth that old age precludes engagement with digital technologies. “Playing the age card” allows older adults a privilege not available to most working-age adults to take personal stands against the aspects of technology they find worrying, threatening or just plain annoying (e.g., online bullying, social isolation, security, T&Cs, etc.). In the clinical trial context, this means taking into account reassurance around security, simplification of T&Cs, and ensuring that digital engagements do not entirely replace social interactions
Voice recognition technology is also likely to play an increasing role. In a study of 50 older adults (most over 80), voice recognition technology helped them feel more connected to family, friends, and the rest of their community. After a connection was made and participants were trained in using the device, they started to explore other ways to interact with it, such as using it to listen to audiobooks and get medication reminders.
Research overwhelmingly shows that older adults understand that technology can help them stay connected, are willing to learn how to use new technology, and are willing to spend time on it, as long as they find it useful and that it brings value to their lives.