Guest post by Sarika Parasuraman, HITLAB Research Manager
One of the most significant threats to the health of Americans age 65 and older is falling. The leading cause of morbidity and mortality among older adults, falls are also the most common cause of nonfatal injuries and hospital admissions for trauma among this population.
It’s no surprise, then, that fall prevention is an area of great interest for researchers committed to improving the health of older adults. HITLAB, for one, has been at the forefront of researching the use of activity monitors – also called actigraphs or accelerometers – in fall risk studies that capture data on people’s physical activity, either via natural, everyday movement, structured exercise or therapeutic interventions.
While this technology and research hold great promise, the challenges of conducting studies with older people – particularly recruiting individuals over age 65 – are no small matter. Our new paper, "Falling short: Recruiting elderly individuals for a fall study," published online and in the March 2013 issue of Ageing Research Reviews, addresses these challenges by analyzing accounts of recruitment strategies in the literature and offering best practices based on published studies and our own researchers’ experiences.
My co-authors Melody Wilding, Liz Seegert, Sonia Rupcic, Margaret Griffin, Stan Kachnowski and I found that researchers typically face a number of recruitment challenges when working with subjects over 65, including:
· Risk of severe outcomes from falls (e.g., hospitalization or even mortality); and
· Institutional policies that limit access to an older adult target population.
One of the most formidable complications involves striking a delicate balance between targeting a recruitment sample at high risk for falls, yet attracting individuals with a sufficiently high cognitive capacity to appropriately consent to study procedures and adhere to activity protocols.
This challenge was highlighted in a small study conducted at HITLAB in spring 2012, in which researchers attempted to recruit participants from nursing home or sub-acute care facilities for a feasibility study, but had to alter eligibility and recruitment criteria in order to meet study goals.
Despite these obstacles, there are a number of approaches researchers can take to navigate difficult methodological decisions and design rigorous, valid – and successful – studies of fall risk and activity:
· Recruit from community-based settings to increase study participation, while recognizing the potential for sample bias and limited study generalizability.
· Utilize short-term activity protocols with non-consecutive data collection periods to promote study involvement among institutionalized older adults (i.e., those living in long-term care facilities).
· Establish eligibility criteria that are not overly exclusive of those with lower cognitive functioning, mobility restrictions, or co-morbidities. However, researchers must remain sensitive to ethical considerations and ensure that there is always access for subjects to immediate medical care.
· When feasible, employ direct mail recruitment methods to reach community-dwelling participants, and use personalized methods where possible.
Overall, researchers must keep in mind that successful recruitment among older adults will require creativity, flexibility, and the ability to adapt to changing situations, especially as use of activity monitoring in fall risk studies continues to grow.
As a researcher or a developer of technology for older adults, what has been your experience in conducting research in this population?