Ageism in Medicine: Systemic Barriers and Inclusive Strategies for Clinical Trials with Older Adults
Original framing: “[Review] Advancing the relevance of clinical trials for older patients” — The Lancet
Marginalised older adults—low‑income, racial minorities, rural dwellers—experience compounded barriers to trial participation, including transportation, mistrust, and digital exclusion. Community‑based participatory research can surface their priorities, such as functional independence and caregiver burden, yet such approaches are rarely funded. Elevating these voices is essential for equity‑focused trial design.
The exclusion of older adults from clinical trials is a legacy of ageist research cultures reinforced by market incentives, regulatory inertia, and a narrow biomedical worldview.
By foregrounding Indigenous ageing philosophies, historical patterns of marginalisation, and cross‑cultural models of elder health, we uncover a multidimensional gap that excludes not only physiological data but also social, spiritual, and community dimensions of wellbeing. Integrating geriatric assessments, incentivising age‑responsive endpoints, and co‑creating research with elder advocacy groups can restructure the trial ecosystem to reflect demographic realities. Policy mandates for transparent, age‑stratified reporting will cement these changes, ensuring that the growing elder population benefits from evidence‑based therapies that respect their diverse lived experiences.