Promoting Health Equity: Integrating Nursing Home Residents into Clinical Trials

Main summary

Clinical trials are constantly being designed and study participants are enrolled to determine whether medical treatments and therapies are safe and effective. Much has been written about the importance of including diverse populations in these trials. However, the nearly 1.4 million people living in the 15,600 nursing homes across the United States have been largely left out of clinical trials, despite the prevalence of such common conditions as hypertension, depression, diabetes and Alzheimer’s disease in this population.

A commentary by faculty at the Regenstrief Institute, Indiana University, UCLA, and the universities of North Carolina, Colorado, and Massachusetts, published in the Journal of the American Geriatrics Society (JAGS), focuses on the importance of including nursing home residents in clinical trials, a population with significant medical complexity. The essay highlights the benefits and challenges of conducting research on medical therapies in nursing homes. The authors identify key elements for successful nursing home clinical trials and propose a network of nursing home clinical trials, noting that it is imperative to ensure diversity, equity, and inclusion in any trial design.

“Among the questions we want to ask are: Is this therapy appropriate for a nursing home population? Does it work in a nursing home population, but are there issues around its implementation? Are there challenges in administering it in a nursing home setting? nursing homes?” notes corresponding author Kathleen Unroe, MD, MHA, MS, a clinical researcher at the Regenstrief Institute and the IU School of Medicine. “Nursing homes were not built to facilitate research. We as researchers need to fit in. We need to appreciate the realities of providing clinical care in this environment and adjust and adapt our protocols to work within that system.”

Among the topics discussed in the commentary:

  • The need for clinical trials in nursing homes
  • Gaps that can be filled with these clinical trials
  • Challenges in conducting these clinical trials
  • Next steps in conducting clinical trials in nursing homes
  • A framework to make a network of clinical trials in nursing homes a reality

“It is imperative that we build the science of nursing home care around testing, prevention, diagnosis and treatment. It is a unique environment that deserves more attention given the essential role it plays in the ongoing care of critically ill adults. sick,” said commentary co-author Susan Hickman, PhD, director of the Regenstrief Institute Aging Research Center and a faculty member at IU’s schools of nursing and medicine.

Citing a missed opportunity, the authors write:

“Inclusion of nursing home residents in COVID-19 therapeutic trials could have identified specific issues related to dosing, administration and monitoring, spurred the creation of specific training materials for nursing home staff and promoted the development of consistent policies to identify appropriate candidates and administer treatments quickly, safely and optimally.”

Dr. Unroe adds:

“Nursing home residents should have access to evidence-based therapies. When we decide not to do the hard work to test them in a nursing home setting, we are setting ourselves up for a much more difficult implementation.” He notes that “conducting trials in nursing homes can generate generalizable knowledge that would also be highly relevant to people cared for in assisted living facilities or even the broader geriatric population living at home.”

“Evaluation of Medical Therapies in the Nursing Home Population: Gaps, Challenges, and Next Steps” is part of a JAGS special collection, “A Changing Landscape for the Evaluation of Novel Therapies for Older Adults and Diverse Populations: National and International Perspectives.” “.

Kathleen T. Unroe, MD, MHA, MS

In addition to being a research scientist at the Indiana University Aging Research Center at the Regenstrief Institute, Kathleen Unroe, MD, MHA, MS, is an associate professor of medicine at the Indiana University School of Medicine and a practicing geriatrician. Dr. Unroe is the founder and CEO of Probari, a healthcare startup supporting nursing home care.

Dr. Susan Hickman

In addition to serving as director and research scientist at the Indiana University Aging Research Center at the Regenstrief Institute, Susan Hickman, PhD, is a professor at the Indiana University School of Nursing, professor of medicine, and professor of Aging. Cornelius and Yvonne Pettinga. She researches at the Indiana University School of Medicine and co-directors the Signature Center for Research in Palliative and End-of-Life Communication and Training (RESPECT) at IU Indianapolis.

Authors and affiliations:

Kathleen T. Unroe MD, MHA, MS1,2,3 | Debra Saliba MD, MPH, AGSF4,5,6,7 | Susan E. Hickman PhD2,3,8 | Dr. Sheryl Zimmerman9,10,11 | Carl Levy, MD, PhD12,13 | Jerry Gurwitz MD14

1Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.

2Indiana University Aging Research Center, Regenstrief Institute Inc., Indianapolis, Indiana, USA.

3Center for Research in Palliative and End-of-Life Communication and Training (RESPECT), Indiana University School of Medicine, Indianapolis, Indiana, USA.

4US Department of Veterans Affairs Greater Los Angeles Health System (VAGLAS) Health Services Research and Development Service (HSR&D) Innovation Center, Los Angeles, California, USA.

5David Geffen School of Medicine, University of California, Los Angeles, California, United States

6Anna and Harry Borun Center for Gerontological Research, Division of Geriatrics, University of California, Los Angeles, California, USA.

7RAND Corporation, Santa Monica, California, USA.

8Indiana University School of Nursing, Indianapolis, Indiana, USA.

9School of Social Work, University of North Carolina, Chapel Hill, North Carolina, USA.

10Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA.

elevenCenter for Excellence in Assisted Living (CEAL), School of Social Work, University of North Carolina, Chapel Hill, North Carolina, USA.

12Division of Geriatric Medicine, Anschutz Campus, University of Colorado School of Medicine, Aurora, Colorado, USA.

13Denver Veterans Affairs Medical Center, Aurora, Colorado, USA

14Division of Geriatric Medicine, UMass Chan School of Medicine, Worcester, Massachusetts, USA.

People with disabilities are commonly excluded from clinical trial eligibility: Despite making up the largest minority group in the US and expressing interest in participating in clinical trials, people with disabilities continue to be excluded.

Attribution/Source(s):

This peer-reviewed publication titled “Promoting Health Equity: Integrating Nursing Home Residents into Clinical Trials” was chosen for publication by Disabled World editors because of its relevance to our readers in the nursing community. with disabilities. While content may have been edited for style, clarity, or brevity, it was originally authored by the Regenstrief Institute and published on 04/29/2024. For further details or clarification, you can contact the Regenstrief Institute directly at regenstrief.org. Please note that Disabled World does not provide any warranty or endorsement related to this item.

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Cite this page (APA): Regenstrief Institute. (2024, April 29). Promoting health equity: Integrating nursing home residents into clinical trials. Disabled world. Retrieved April 29, 2024 from www.disabled-world.com/medical/clinical-trials/equity-health.php

Permanent link: Promoting Health Equity: Integrating Nursing Home Residents into Clinical Trials: The commentary focuses on the importance of including nursing home residents, a population with significant medical complexity, in clinical trials.

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