Recruiting senior citizens presents no shortage of challenges to clinical trials organisers. Several studies have found that the over-65 age group is significantly underrepresented in clinical trial participation. This contrasts worryingly with the increasing importance of elderly individuals to research studies given the range of illnesses and diseases prevalent in our ageing population.
The factors that influence recruitment are largely determined by the type of research study being done, nevertheless, studies on the subject of recruitment have found some strategies which have been shown to improve the recruitment of seniors, especially, almost universally.
1) Make Travel Easier
Travel is perhaps the most significant barrier to participation for senior patients, a 2007 study published in the International Review of Neurobiology found that unwillingness to travel accounted for 33.6% of failures to recruit eligible patients. Many seniors have restricted mobility, and many more are no longer able to drive themselves or are confident or comfortable using public transport.
The key to overcoming this challenge when recruiting patients is to make sites as accessible as possible. This can be done through offering reimbursement for travel expenses incurred or, better still, providing transportation to sites where possible. Another important factor is targeting recruitment in the locality of sites to ensure they are accessible to eligible patients.
2) Balance the “Benefit:Burden Ratio”
Key to patient recruitment for any study is minimizing the burden of participation while emphasizing and maximizing the benefits to potential participants. This can also be seen as balancing the ‘benefit:burden ratio’. Seniors’ burden to participation is usually much greater than younger patients, and so they require more attention in order to ensure that their burden is minimized. This can be achieved through staff taking extra time to build relationships of trust with eligible seniors, through regular conversation by phone or face-to-face. Staff should also emphasize the benefits of participating in the study and ease participants’ worries by ensuring aspects of participation such as transportation are as comfortable and accommodating as possible for the patient.
Senior patients may be prone to confusion or forgetfulness, and sites which enable staff to build familiarity and trust with potential participants will see their efforts much more likely to be rewarded with increased recruitment and enrolment results.
3) Partner with Community Organizations
Whilst media and technology provide a wealth of opportunities for patient recruitment, evidence suggests that new methods remain no substitute for old-fashioned ‘face-to-face’ recruitment. One study, for example, reported that 79% of its enrollees were first contacted through face-to-face interactions[1]. Partnering with community organizations is a method that has proven successful for many studies when seeking to recruit participants face-to-face.
4) Invest in Social Marketing
It is a common myth that only the young are active on social media, but this perpetual misconception is becoming increasingly outdated, almost by the day, as the number of seniors using social media continues to rise. Here are a few statistics:
· Half of Internet users aged 65+ have a social media account.
· The number of over-65’s using social media increased by 50% over the last year alone.
· 9/10 seniors using social media have a Facebook account.
When considering these facts, it is clear that social media presents a rich opportunity for clinical trial recruiters to capture the attention of seniors. The fact that advertising on social media is good value and extremely effective adds further weight to the argument that clinical trials professionals can’t afford not to be using social media to reach potential participants.
5) Pick Up The Phone
The telephone can be an important strategic tool when it comes to patient recruitment, and especially when targeting senior patients. Evidence from several studies suggests that both telephone reminders and SMS alerts are effective at increasing study enrollment. The reason is that sometimes people just need a reminder (or two) that there is a study they are eligible for. Seniors can often be forgetful, and reminders are a simple way to ensure that eligible patients do not miss out on participation.
[1] McHenry JC, Insel KC, Einstein GO, Vidrine AN, Koerner KM, Morrow DG. Recruitment of Older Adults: Success May Be in the Details. The Gerontologist. 2015;55(5):845-853. doi:10.1093/geront/gns079.