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Which older adults refuse to or dropout from participation in a trial of integrated care in Singapore and why? Insights from quantitative and qualitative data

Authors:
World Congress on Integrated Care 2013, Singapore, November 7-9, 2013.
Volume 13, 18 December 2013
Publisher: Igitur publishing
URL: http://www.ijic.org
Cite this as: Int J Integr Care 2013; WCIC Conf Suppl; URN:NBN:NL:UI:10-1-116007
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Conference Abstract
Which older adults refuse to or dropout from participation in a trial of
integrated care in Singapore and why? Insights from quantitative and
qualitative data
T. Wu, Research and Evaluation, Tsao Foundation, Singapore, Singapore
S. Chua, Medical Social Services, Alexandra Hospital, Singapore, Singapore
L. Lim, Medical Social Services, Singapore General Hospital, Singapore, Singapore
L. Ow Yong, Medical Social Services, Singapore General Hospital, Singapore, Singapore
A. Tan, Medical Social Services, Singapore General Hospital, Singapore, Singapore
W. Ng, Hua Mei EPICC, Tsao Foundation, Singapore, Singapore
K. Peh, Hua Mei EPICC, Tsao Foundation, Singapore, Singapore
K. Lee, Family Medicine, Singapore General Hospital, Singapore, Singapore
Correspondence to: Dr. Treena Wu, Ph.D, Manager (Research and Programme Evaluations), Tsao
Foundation, Singapore, E-mail: treena@tsaofoundation.org
Abstract
Study Objectives: Clinical trials with frail older adults are associated with low recruitment rates and
high dropout rates. A review of major funded UK trials found that less than one-third recruited their
original target within the time originally specified [1]. This paper aims to examine the recruitment and
dropout rates of frail older Singaporeans in a trial of a three year integrated care program (EPICC).
Methodology: The target was to recruit 80 frail patients aged 60+ prior to SGH and AH acute care
discharge and randomly assigned to two arms, over four months. Logistics and administrative
procedures for recruitment were studied. Profiles of recruited and dropout patients were collected. If
patients refused to participate in the recruitment or were recruited and then dropped out, they were
asked their reasons for doing so.
Results: 113 patients had to be recruited over 13 months in order to meet the original target.
Reasons for non-participation (n=37) included patients had difficulty understanding why there should
be clinical trials in elder care (35.1%); ineligibility due to incorrect frailty assessment (27%); patients
were on the nursing home waiting list (13.5%).
Conclusion: Improved logistics and administrative procedures for recruitment in acute care; and
effective communication with older patients will decrease exclusion of older adults from clinical
research.
World Congress on Integrated Care 2013, Singapore, November 7-9, 2013.
International Journal of Integrated Care Volume 13, 18 December URN:NBN:NL:UI:10-1-116007 http://www.ijic.org/
Keywords:
recruitment, participation, clinical trials, frail, older
Reference:
1. McMurdo MET et al. Improving recruitment of older people to research through good practice. Age
and Aging 2011; 40:659665
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Article
There is widespread evidence both of the exclusion of older people from clinical research, and of under-recruitment to clinical trials. This review and opinion piece provides practical advice to assist researchers both to adopt realistic, achievable recruitment rates and to increase the number of older people taking part in research. It analyses 14 consecutive recently published trials, providing the number needed to be screened to recruit one older participant (around 3:1), numbers excluded (up to 49%), drop out rates (5-37%) and whether the planned power was achieved. The value of planning and logistics are outlined, and approaches to optimising recruitment in hospital, primary care and care home settings are discussed, together with the challenges of involving older adults with mental incapacity and those from minority groups in research. The increasingly important task of engaging older members of the public and older patients in research is also discussed. Increasing the participation of older people in research will improve the generalisability of research findings and inform best practice in the clinical management of the growing older population.