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Winter 2023

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Age-Wise Strategies: Including Older Adults in Your Behavioral Medicine Research

Heather Derry-Vick, PhD; Ryan Mace, PhD; Meghan Mattos, PhD, RN, CNL; Madhura Phansikar, PhD; and Michelle Jaldin, MPH; Aging SIG Leadership Team

Harmful, negative stereotypes about aging (ageism) permeate our society, and often go unchallenged. A recent “Aged” filter on TikTok went viral and revealed deep fears and prejudices about aging.  The “anti-aging” cosmetic industry was worth over $50 billion in 2022 and is expected to nearly double over the next decade.[1] These trends and societal messages are misleading because there is a large range of what it means or looks like to be an older adult. Further, ageism is harmful to health.[2]

It is critical that, as behavioral medicine professionals, we examine our own biases about aging and work to minimize ageism in our work.  Some forms of ageism are explicit. For example, terms such as “senior moment” perpetuate misconceptions that memory loss is expected with aging. Other forms of ageism are implicit. This includes beliefs that older adults need to rest as much as possible and reduce time spent doing household chores, cooking, or traveling – when in fact, engaging in these activities and the community is helpful throughout adulthood.

Given that the risk for chronic conditions increases with age, older adults can benefit greatly from behavioral research innovations and should be appropriately represented in research studies.  On behalf of the Aging SIG, we offer several tips for investigators to reduce ageism and promote the inclusion of older adults in their work.

What should I consider when developing eligibility criteria?

Older adults are significantly underrepresented in clinical trials.[3,4] Medical comorbidities, concerns about adherence, and use of medications are among the reasons that older adults are excluded from clinical trials. To address this, consider your study’s eligibility criteria carefully. There should not be an age limit in studies broadly intended for adults, unless scientifically justified (e.g., studying an issue specific to middle-aged adults). Determine whether exclusionary physical and cognitive criteria are truly needed for your study activities. When possible, eliminate eligibility criteria that disproportionally impact demographically diverse older adults (e.g., language requirements, specific residential statuses).

How can I improve the experience of older adults during study recruitment and data collection? 

Using large font and high contrast in recruitment ads and study materials can be easier to read for all prospective participants, including those with age-related vision changes.  Offering multiple formats for study assessments (e.g., paper-pencil and online; remote and in-person), and opportunities for assistance if needed, can also improve accessibility.  Offer help with study activities/tools to all participants, rather than assuming that only older adults will need help (e.g., for functional fitness assessments).

I’m testing a technology-based intervention. Should I enroll older adults?

Absolutely! Most older adults already use technology, and many others would like to learn.[5] Older adults are even outpacing younger in adopting digital health tools that many of us within SBM aim to develop. Don’t assume that all older adults will need assistance to use technology, or that younger adults will not! Instead, assess the range of factors influencing technology use, such as user preferences, access to broadband, devices, and sensory functions (e.g., visual or hearing impairments). For participants who need assistance, researchers can use evidence-based strategies to teach technology use. These include involving loved ones or caregivers and allowing time for experimentation. Including older adults in the intervention development phases of your work can also improve accessibility and uptake in the future phases of your research.

When I present my results, how can I avoid ageist language?

Unfortunately, common language in our day-to-day conversations can often invoke negative stereotypes about aging.  Avoid language that portrays a negative view of aging (such as “suffering from aging” or “combatting aging”) – aging comes with challenges, benefits, and strengths!  Instead of using “other-ing” terms like “the elderly,” consider using “older people” or “older participants.” Visit the National Center for Reframing Aging website for a tip sheet, and read about manuscript guidelines for inclusive language.

Where can I turn for questions about my behavioral medicine study’s inclusion of older adults?

Feel free to contact the Aging SIG by emailing the leadership team or tagging us on social media  (@SBMAgingSIG on X), to source the collective knowledge of our SIG members. 

Resources:

  1. National Center to Reframe Aging: https://www.reframingaging.org/
  2. Petrovsky, D.V., Ðoàn, L.N., Loizos, M., O'Conor, R., Prochaska, M., Tsang, M., Hopman-Droste, R., Klinedinst, T.C., Mathur, A., Bandeen-Roche, K., van der Willik, O., Kritchevsky, S.B. (2022). Key recommendations from the 2021 "inclusion of older adults in clinical research" workshop. Journal of Clinical and Translational Science, 6(1), e55. doi: https://doi.org/10.1017/cts.2022.1
  3. Old School Anti-Ageism Clearinghouse: https://oldschool.info/
  4. Czaja, S. J., Boot, W. R., Charness, N., & Rogers, W. A. (2019). Designing for older adults: Principles and creative human factors approaches (3rd ed.). CRC Press/Routledge/Taylor & Francis Group. doi: https://doi.org/10.1201/b22189

References:

  1. Anti-Aging Cosmetics Market Size To Hit USD 90.32 Bn By 2032. (n.d.). Retrieved November 16, 2023, from https://www.precedenceresearch.com/anti-aging-cosmetics-market
  2. Levy, B. R., Slade, M. D., Chang, E.-S., Kannoth, S., & Wang, S.-Y. (2020). Ageism Amplifies Cost and Prevalence of Health Conditions. The Gerontologist, 60(1), 174–181. https://doi.org/10.1093/geront/gny131
  3. Scher, K. S., & Hurria, A. (2012). Under-Representation of Older Adults in Cancer Registration Trials: Known Problem, Little Progress. Journal of Clinical Oncology, 30(17), 2036–2038. https://doi.org/10.1200/JCO.2012.41.6727
  4. Lau, S. W. J., Huang, Y., Hsieh, J., Wang, S., Liu, Q., Slattum, P. W., Schwartz, J. B., Huang, S.-M., & Temple, R. (2022). Participation of Older Adults in Clinical Trials for New Drug Applications and Biologics License Applications From 2010 Through 2019. JAMA Network Open, 5(10), e2236149. https://doi.org/10.1001/jamanetworkopen.2022.36149
  5. Mace, R. A., Mattos, M. K., & Vranceanu, A.-M. (2022). Older adults can use technology: Why healthcare professionals must overcome ageism in digital health. Translational Behavioral Medicine, 12(12):1102-1105. https://doi.org/10.1093/tbm/ibac070