Practice-Changing Studies in Geriatric Medicine Within the Last 10 Years
Recent practice-changing studies in geriatric medicine have significantly improved care for older adults, with oncology trials showing similar outcomes between older and younger patients despite historical underrepresentation of geriatric populations in clinical research.
Representation of Older Adults in Clinical Trials
Oncology Trials
A comprehensive 2022 analysis of practice-changing oncology trials revealed important insights about geriatric representation 1:
44% of participants in practice-changing oncology trials were older adults
Representation varied by cancer type:
- 49% in prostate cancer trials
- 38% in pancreatic cancer trials
- 37% in breast cancer trials
- 34% in non-small cell lung cancer trials
Representation also varied by therapeutic approach:
- 54% in hormonal/targeted therapy trials
- 44% in cytotoxic chemotherapy trials
- Only 20% in immunotherapy trials
- 34% in combination therapy trials
Key Finding on Treatment Outcomes
The most significant finding was that older adults included in these trials showed similar overall survival (OS) and progression-free survival (PFS) outcomes compared to younger patients across all cancer types and treatment approaches 1. This challenges previous assumptions about differential treatment efficacy in older populations.
Major Gaps in Geriatric Research
Despite improved representation, critical gaps remain:
Lack of adverse effect reporting by age: No trials reported adverse effects stratified by age, despite this being crucial for clinical decision-making in older adults 1
Absence of quality-of-life metrics by age: None of the practice-changing trials reported quality-of-life outcomes by age, despite this being particularly important for older adults who face complex tradeoffs between quality and length of life 1
Restrictive enrollment criteria: Most trials (60%) used restrictive performance status criteria (ECOG PS 0-1) that effectively exclude frailer older adults 1
Evolving Field of Geriatric Cardiology
The field of geriatric cardiology has emerged as a critical specialty addressing the intersection of cardiovascular disease and aging 2:
- Focuses on managing cardiovascular disease in the context of:
- Multimorbidity
- Polypharmacy
- Frailty
- Cognitive decline
- Social and psychological dimensions of aging
This approach represents a paradigm shift from disease-focused to patient-centered care for older adults with cardiovascular disease 2.
Practice-Changing Interventions
Several specific interventions have shown promise:
Modified Hospital Elder Life Program: Demonstrated effectiveness in reducing post-surgical delirium 3
Reduction of inappropriate medications in nursing homes: Targeted interventions have successfully reduced polypharmacy in long-term care settings 3
Novel exercise programs: Specialized exercise interventions have shown benefits for mobility in older adults 3
Self-driven advance care planning: New approaches to advance care planning have improved end-of-life care 3
Transcatheter aortic valve implantation (TAVI): Studies have examined cognitive outcomes after this less-invasive cardiac procedure 3
Challenges in Implementation
Despite these advances, implementing geriatric-specific approaches faces challenges:
- Limited infrastructure and resources for specialized geriatric care 4
- Shortened hospital stays (3-4 days) that may not allow for comprehensive geriatric assessment 4
- Need for increased geriatric training across medical specialties 4
Future Directions
The field of geriatrics continues to evolve with focus on:
- Integrating geriatric principles across medical specialties
- Developing more inclusive clinical trial designs
- Addressing quality of life alongside survival outcomes
- Expanding the geriatric workforce to meet growing needs
The evidence suggests that while progress has been made in including older adults in practice-changing research, significant work remains to fully address the complex needs of this growing population.