Examining the evidence: a systematic review of the inclusion and analysis of older adults in randomized controlled trials.

Abstract:

BACKGROUND:Due to a shortage of studies focusing on older adults, clinicians and policy makers frequently rely on clinical trials of the general population to provide supportive evidence for treating complex, older patients. OBJECTIVES:To examine the inclusion and analysis of complex, older adults in randomized controlled trials. REVIEW METHODS:A PubMed search identified phase III or IV randomized controlled trials published in 2007 in JAMA, NEJM, Lancet, Circulation, and BMJ. Therapeutic interventions that assessed major morbidity or mortality in adults were included. For each study, age eligibility, average age of study population, primary and secondary outcomes, exclusion criteria, and the frequency, characteristics, and methodology of age-specific subgroup analyses were reviewed. RESULTS:Of the 109 clinical trials reviewed in full, 22 (20.2%) excluded patients above a specified age. Almost half (45.6%) of the remaining trials excluded individuals using criteria that could disproportionately impact older adults. Only one in four trials (26.6%) examined outcomes that are considered highly relevant to older adults, such as health status or quality of life. Of the 42 (38.5%) trials that performed an age-specific subgroup analysis, fewer than half examined potential confounders of differential treatment effects by age, such as comorbidities or risk of primary outcome. Trials with age-specific subgroup analyses were more likely than those without to be multicenter trials (97.6% vs. 79.1%, p < 0.01) and funded by industry (83.3% vs. 62.7%, p < 0.05). Differential benefit by age was found in seven trials (16.7%). CONCLUSION:Clinical trial evidence guiding treatment of complex, older adults could be improved by eliminating upper age limits for study inclusion, by reducing the use of eligibility criteria that disproportionately affect multimorbid older patients, by evaluating outcomes that are highly relevant to older individuals, and by encouraging adherence to recommended analytic methods for evaluating differential treatment effects by age.

journal_name

J Gen Intern Med

authors

Zulman DM,Sussman JB,Chen X,Cigolle CT,Blaum CS,Hayward RA

doi

10.1007/s11606-010-1629-x

subject

Has Abstract

pub_date

2011-07-01 00:00:00

pages

783-90

issue

7

eissn

0884-8734

issn

1525-1497

journal_volume

26

pub_type

杂志文章,评审
  • Self-referral for screening mammography.

    abstract::Patients can obtain screening mammograms without a physician's referral, leading to potential problems in clinical care. Because of the complexity of self-referral and the limitations of prior studies, we examined this phenomenon in a representative sample of mammography facilities. A questionnaire was given to all wo...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1046/j.1525-1497.1998.00209.x

    authors: Suter LG,Elmore JG

    更新日期:1998-10-01 00:00:00

  • Using Health Systems Engineering Approaches to Prepare for Tailoring of Implementation Interventions.

    abstract:BACKGROUND:Implementation of evidence-based practices often requires tailoring implementation strategies to local contextual factors, including available resources, expertise, and cultural norms. Using an exemplar case, we describe how health systems engineering methods can be used to understand system-level variation ...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-020-06121-5

    authors: Barnes GD,Acosta J,Kurlander JE,Sales AE

    更新日期:2020-08-31 00:00:00

  • Gender differences in patients with chronic fatigue syndrome.

    abstract:OBJECTIVE:To determine whether there are differences between men and women patients who have chronic fatigue syndrome (CFS) and, if so, to ascertain whether a gender-related pattern exists. DESIGN:A descriptive study of demographic, clinical, and psychosocial measures, the results of which were prospectively collected...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/BF02629522

    authors: Buchwald D,Pearlman T,Kith P,Schmaling K

    更新日期:1994-07-01 00:00:00

  • Reduction of polypharmacy by feedback to clinicians.

    abstract:OBJECTIVE:To determine whether two different educational interventions would reduce polypharmacy in outpatients receiving ten (10) or more active medications at the Denver Veterans Affairs Center. DESIGN:292 patients were randomized into three (3) groups: Control (n = 88); simple notification of primary care provider ...

    journal_title:Journal of general internal medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1007/BF02598309

    authors: Meyer TJ,Van Kooten D,Marsh S,Prochazka AV

    更新日期:1991-03-01 00:00:00

  • Chapter 2: medical tests guidance (2) developing the topic and structuring systematic reviews of medical tests: utility of PICOTS, analytic frameworks, decision trees, and other frameworks.

    abstract::Topic development and structuring a systematic review of diagnostic tests are complementary processes. The goals of a medical test review are to identify and synthesize evidence to evaluate the impacts alternative testing strategies on health outcomes and to promote informed decision making. A common challenge is that...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-012-2007-7

    authors: Samson D,Schoelles KM

    更新日期:2012-06-01 00:00:00

  • Isolated renal relapse of sarcoidosis under low-dose glucocorticoid therapy.

    abstract::Sarcoidosis is a multisystem disease of unknown etiology. Renal manifestation is rare and usually caused by hypercalcemia and nephrocalcinosis. Moreover, renal disease can occur as granulomatous interstitial nephritis (GIN), which is a histological diagnosis. We describe a case of sarcoidosis first presenting with mul...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-008-0603-3

    authors: Mayer C,Müller A,Halbritter J,Wirtz H,Stumvoll M

    更新日期:2008-06-01 00:00:00

  • The Development and Evaluation of an Online Healthcare Toolkit for Autistic Adults and their Primary Care Providers.

    abstract:BACKGROUND:The healthcare system is ill-equipped to meet the needs of adults on the autism spectrum. OBJECTIVE:Our goal was to use a community-based participatory research (CBPR) approach to develop and evaluate tools to facilitate the primary healthcare of autistic adults. DESIGN:Toolkit development included cogniti...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-016-3763-6

    authors: Nicolaidis C,Raymaker D,McDonald K,Kapp S,Weiner M,Ashkenazy E,Gerrity M,Kripke C,Platt L,Baggs A

    更新日期:2016-10-01 00:00:00

  • Teaching residents to work with torture survivors: experiences from the Bronx Human Rights Clinic.

    abstract:INTRODUCTION:Despite the 1984 United Nations's Convention Against Torture calling to train doctors to work with torture survivors, many physicians are unaware of their obligation and few are taught the requisite clinical skills. AIM:To describe the development, implementation, and evaluation of a curriculum to teach r...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-008-0592-2

    authors: Metalios EE,Asgary RG,Cooperman N,Smith CL,Du E,Modali L,Sacajiu G

    更新日期:2008-07-01 00:00:00

  • Models, strategies, and tools. Theory in implementing evidence-based findings into health care practice.

    abstract::This paper presents a case for careful consideration of theory in planning to implement evidence-based practices into clinical care. As described, theory should be tightly linked to strategic planning through careful choice or creation of an implementation framework. Strategies should be linked to specific interventio...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1111/j.1525-1497.2006.00362.x

    authors: Sales A,Smith J,Curran G,Kochevar L

    更新日期:2006-02-01 00:00:00

  • Do physicians spend more time with non-English-speaking patients?

    abstract:OBJECTIVE:To determine whether physicians at a general internal medicine clinic spend more time with non-English-speaking patients. DESIGN:A time-motion study comparing physician time spent with non-English-speaking patients and time spent with English-speaking patients during 5 months of observation. We also tested p...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1046/j.1525-1497.1999.00338.x

    authors: Tocher TM,Larson EB

    更新日期:1999-05-01 00:00:00

  • Presence and correlates of racial disparities in adherence to colorectal cancer screening guidelines.

    abstract:OBJECTIVES:We examined the presence and correlates of Black/White racial disparities in adherence to guidelines for colorectal cancer screening (CRCS). METHODS:The sample included 328 Black and 1827 White patients age 50-75 from 24 VA medical facilities who responded to a mailed survey with phone follow-up (response r...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1007/s11606-010-1575-7

    authors: Burgess DJ,van Ryn M,Grill J,Noorbaloochi S,Griffin JM,Ricards J,Vernon SW,Fisher DA,Partin MR

    更新日期:2011-03-01 00:00:00

  • Uptake of electronic prescribing in community-based practices.

    abstract:BACKGROUND:Electronic prescribing (e-prescribing) has the potential to improve the safety and efficiency of medication use, but uptake of e-prescribing in community-based settings has been limited to date. In April 2004, 2 large insurers in Massachusetts began a program to fund e-prescribing systems for targeted clinic...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-007-0383-1

    authors: Fischer MA,Vogeli C,Stedman MR,Ferris TG,Weissman JS

    更新日期:2008-04-01 00:00:00

  • Provider Misinterpretation, Documentation, and Follow-Up of Definitive Urine Drug Testing Results.

    abstract:BACKGROUND:Urine drug testing (UDT) is an essential tool to monitor opioid misuse among patients on chronic opioid therapy. Inaccurate interpretation of UDT can have deleterious consequences. Providers' ability to accurately interpret and document UDT, particularly definitive liquid chromatography-tandem mass spectrome...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-019-05514-5

    authors: Chua I,Petrides AK,Schiff GD,Ransohoff JR,Kantartjis M,Streid J,Demetriou CA,Melanson SEF

    更新日期:2020-01-01 00:00:00

  • Relationship between literacy, knowledge, self-care behaviors, and heart failure-related quality of life among patients with heart failure.

    abstract:BACKGROUND:We sought to examine the relationship between literacy and heart failure-related quality of life (HFQOL), and to explore whether literacy-related differences in knowledge, self-efficacy and/or self-care behavior explained the relationship. METHODS:We recruited patients with symptomatic heart failure (HF) fr...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1007/s11606-011-1668-y

    authors: Macabasco-O'Connell A,DeWalt DA,Broucksou KA,Hawk V,Baker DW,Schillinger D,Ruo B,Bibbins-Domingo K,Holmes GM,Erman B,Weinberger M,Pignone M

    更新日期:2011-09-01 00:00:00

  • Missed opportunities: family history and behavioral risk factors in breast cancer risk assessment among a multiethnic group of women.

    abstract:BACKGROUND:Clinician's knowledge of a woman's cancer family history (CFH) and counseling about health-related behaviors (HRB) is necessary for appropriate breast cancer care. OBJECTIVE:To evaluate whether clinicians solicit CFH and counsel women on HRB; to assess relationship of well visits and patient risk perception...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-006-0087-y

    authors: Karliner LS,Napoles-Springer A,Kerlikowske K,Haas JS,Gregorich SE,Kaplan CP

    更新日期:2007-03-01 00:00:00

  • Are Improvements Still Needed to the Modified Hospital Readmissions Reduction Program: a Health and Retirement Study (2000-2014)?

    abstract:BACKGROUND:To address concerns that the Hospital Readmissions Reduction Program (HRRP) unfairly penalized safety net hospitals treating patients with high social and functional risks, Medicare recently modified HRRP to compare hospitals with similar proportions of high-risk, dual-eligible patients ("peer group hospital...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-020-06222-1

    authors: Hsuan C,Braun TM,Ponce NA,Hoffman GJ

    更新日期:2020-12-01 00:00:00

  • Annual Spending per Patient and Quality in Hospital-Owned Versus Physician-Owned Organizations: an Observational Study.

    abstract:BACKGROUND:Recent studies that compared patient spending in hospital-owned physician practices versus physician-owned groups did not compare quality of care. Past studies had incomplete measures of physician-hospital integration, or lacked patient-level data. OBJECTIVE:To measure the association between physician-hosp...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-019-05312-z

    authors: Ho V,Metcalfe L,Vu L,Short M,Morrow R

    更新日期:2020-03-01 00:00:00

  • Gender differences in aspirin use among adults with coronary heart disease in the United States.

    abstract:BACKGROUND:Aspirin reduces mortality for men and women with coronary heart disease (CHD). Previous research suggests women with acute coronary syndromes receive less aggressive care, including less frequent early administration of aspirin. The presence of gender differences in aspirin use for secondary prevention is le...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-007-0116-5

    authors: Opotowsky AR,McWilliams JM,Cannon CP

    更新日期:2007-01-01 00:00:00

  • Optimal management strategies for HIV-infected patients who present with cough or dyspnea: a cost-effective analysis.

    abstract:OBJECTIVE:To determine the effectiveness and costs of alternative management strategies for patients infected with the human immunodeficiency virus (HIV) who present with pulmonary symptoms. DESIGN:Decision analysis comparing initial testing (arterial blood gas analysis, induced sputum analysis, or bronchoscopy with b...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,评审

    doi:10.1007/BF02598081

    authors: Freedberg KA,Tosteson AN,Cotton DJ,Goldman L

    更新日期:1992-05-01 00:00:00

  • Exploring the educational value of clinical vignettes from the Society of General Internal Medicine national meeting in the internal medicine clerkship: a pilot study.

    abstract:INTRODUCTION:Whether the clinical vignettes presented at the Society of General Internal Medicine (SGIM) annual meeting could be of educational value to third year students in the Internal Medicine clerkship has not been studied. OBJECTIVE:To explore the relevance and learning value of clinical vignettes from the SGIM...

    journal_title:Journal of general internal medicine

    pub_type:

    doi:10.1111/j.1525-1497.2006.00596.x

    authors: Wofford JL,Singh S

    更新日期:2006-11-01 00:00:00

  • Behavioral Treatment for Veterans with Obesity: 24-Month Weight Outcomes from the ASPIRE-VA Small Changes Randomized Trial.

    abstract:BACKGROUND:Small Changes (SC) is a weight management approach that demonstrated superior 12-month outcomes compared to the existing MOVE!® Weight Management Program at two Veterans Affairs (VA) sites. However, approaches are needed to help graduates of treatment continue to lose or maintain their weight over the longer...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1007/s11606-017-3987-0

    authors: Lutes LD,Damschroder LJ,Masheb R,Kim HM,Gillon L,Holleman RG,Goodrich DE,Lowery JC,Janney C,Kirsh S,Richardson CR

    更新日期:2017-04-01 00:00:00

  • The accuracy of clinician perceptions of "usual" blood pressure control.

    abstract:BACKGROUND:The term "clinical inertia" is used to describe the failure to manage a chronic condition aggressively enough to bring it under control. The underlying mechanisms for clinical inertia remain poorly understood. OBJECTIVE:To describe one potential mechanism for clinical inertia, seen through the lens of clini...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1007/s11606-007-0464-1

    authors: Rose AJ,Shimada SL,Rothendler JA,Reisman JI,Glassman PA,Berlowitz DR,Kressin NR

    更新日期:2008-02-01 00:00:00

  • Using Active Choice Within the Electronic Health Record to Increase Influenza Vaccination Rates.

    abstract:BACKGROUND:Despite the benefits of influenza vaccination, each year more than half of adults in the United States do not receive it. OBJECTIVE:To evaluate the association between an active choice intervention in the electronic health record (EHR) and changes in influenza vaccination rates. DESIGN:Observational study....

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1007/s11606-017-4046-6

    authors: Patel MS,Volpp KG,Small DS,Wynne C,Zhu J,Yang L,Honeywell S Jr,Day SC

    更新日期:2017-07-01 00:00:00

  • The effect of patient race and blood pressure control on patient-physician communication.

    abstract:BACKGROUND:Racial disparities in hypertension control contribute to higher rates of cardiovascular mortality among blacks. Patient-physician communication quality is associated with better health outcomes, including blood pressure (BP) control. Both race/ethnicity and BP control may adversely affect communication. OBJ...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1007/s11606-009-1051-4

    authors: Cené CW,Roter D,Carson KA,Miller ER 3rd,Cooper LA

    更新日期:2009-09-01 00:00:00

  • Prior Choices of Between-Study Heterogeneity in Contemporary Bayesian Network Meta-analyses: an Empirical Study.

    abstract:BACKGROUND:Network meta-analysis (NMA) is a popular tool to compare multiple treatments in medical research. It is frequently implemented via Bayesian methods. The prior choice of between-study heterogeneity is critical in Bayesian NMAs. This study evaluates the impact of different priors for heterogeneity on NMA resul...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-020-06357-1

    authors: Rosenberger KJ,Xing A,Murad MH,Chu H,Lin L

    更新日期:2021-01-05 00:00:00

  • HIV risk screening in the primary care setting. Assessment of physicians skills.

    abstract:OBJECTIVE:To assess the content and extent of HIV risk assessment by primary care physicians across a diverse panel of patients with unidentified HIV risk behaviors. DESIGN:Standardized patient examination to assess primary care physicians' skills at identifying and managing HIV infection and overall clinical skills. ...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1046/j.1525-1497.1997.00015.x

    authors: Wenrich MD,Curtis JR,Carline JD,Paauw DS,Ramsey PG

    更新日期:1997-02-01 00:00:00

  • Identification of limited English proficient patients in clinical care.

    abstract:BACKGROUND:Standardized means to identify patients likely to benefit from language assistance are needed. OBJECTIVE:To evaluate the accuracy of the U.S. Census English proficiency question (Census-LEP) in predicting patients' ability to communicate effectively in English. DESIGN:We investigated the sensitivity and sp...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-008-0693-y

    authors: Karliner LS,Napoles-Springer AM,Schillinger D,Bibbins-Domingo K,Pérez-Stable EJ

    更新日期:2008-10-01 00:00:00

  • Clinic HIV-focused features and prevention of Pneumocystis carinii pneumonia.

    abstract:OBJECTIVE:To examine the association of clinic HIV-focused features and advanced HIV care experience with Pneumocystis carinii pneumonia (PCP) prophylaxis and development of PCP as the initial AIDS diagnosis. DESIGN:Nonconcurrent prospective study. SETTING:New York State Medicaid Program. PARTICIPANTS:Medicaid enrol...

    journal_title:Journal of general internal medicine

    pub_type: 临床试验,杂志文章,多中心研究

    doi:10.1046/j.1525-1497.1998.00003.x

    authors: Turner BJ,Markson L,Cocroft J,Cosler L,Hauck WW

    更新日期:1998-01-01 00:00:00

  • Cost-related skipping of medications and other treatments among Medicare beneficiaries between 1998 and 2000. Results of a national study.

    abstract:OBJECTIVE:To report rates of cost-related skipping of medications and other treatments, assess correlates of skipping, examine changes in skipping between 1998 and 2000, and identify factors associated with changes in skipping. DESIGN, SETTING, AND PARTICIPANTS:Cross-sectional and longitudinal analyses of surveys of a...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1111/j.1525-1497.2005.0128.x

    authors: Wilson IB,Rogers WH,Chang H,Safran DG

    更新日期:2005-08-01 00:00:00

  • Risk of cardiovascular events and death--does insurance matter?

    abstract:BACKGROUND:Many Americans lack health insurance. Despite good evidence that lack of insurance compromises access to care, few prospective studies examine its relationship to health outcomes. OBJECTIVE:To determine the relationship between insurance and cardiovascular outcomes and the relationship between insurance and...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-007-0127-2

    authors: Fowler-Brown A,Corbie-Smith G,Garrett J,Lurie N

    更新日期:2007-04-01 00:00:00