Researchers Look to Include LTC Residents

Abstract

Senior contributing writer Joanne Kaldy is a freelance writer in Hagerstown, Md., and a communications consultant for AMDA and other organizations. Why do some elderly patients become frail and others go on to run marathons? William Ershler, MD, a researcher at the National Institute on Aging, is studying this issue and hopes that his research will discover pathways to frailty and how patients might avoid them. In future studies, Dr. Ershler will look in particular at the inflammatory pathway as a possible precursor to frailty. “We have two protocols in the works that will test the anti-inflammatory effects of two drugs. Subjects will be patients on the trajectory toward frailty [who are] … not quite yet frail,” he explained. Dr. Ershler was a featured speaker at the AMDA Foundation's Fall Research Network Conference in Baltimore last month. He noted how challenging it can be to conduct studies involving older patients. “Having been in the private sector and engaged in research in that setting, there are barriers just to getting all the resources necessary to do these studies. Getting informed consent, securing the buy in of family, and other issues can create some obstacles that are difficult to overcome,” he said. As for the subjects themselves, he said, “Older people have a healthy degree of skepticism toward clinical trials, [but] there is a group of them who participate in studies with a vengeance.” He and many other researchers often exclude nursing facility residents from studies, Dr. Ershler admitted. “We target community-dwelling, ambulatory people for the most part and shy away from people in nursing homes,” he said. “There are many potential subjects in nursing homes, but it's a matter of making sure they understand the study, the encumbrances, and what's in it for them. There are a whole different set of concerns than there are with community-dwelling patients.” However, Dr. Ershler said that nursing facilities are ripe for research. “There are so many questions about this population out there that need to be answered.” He offered some ideas for obtaining informed consent in this setting. “In one study, we developed a video that discussed, in simple ways, the rationale for the study and why it was important. We gave it to participants and asked them to view it with their families,” he said. “This is something that could be done in nursing homes.” Even though Dr. Ershler finds it hard to involve nursing facility patients in his research, he said that the information to be gleaned from such studies is relevant to geriatric and LTC practice. “We hope to be able to take basic observations about the mechanisms involved in frailty and develop target therapies accordingly,” he said. In an interview before the conference, Dr. Ershler said that he wants to hear from others about “the biology of frailty and what kind of reversals they think we can achieve. I would love to hear about possible interventions that might be useful in this population.” Currently, he said “we have data on antecedents to frailty …. There are certain pathways that go astray, and if you can right the ship early, you can prevent frailty.” Virginia-based medical director and researcher Daniel Bluestein, MD, CMD, noted that research on frailty is valuable for long-term care practitioners. “One of the tough decisions we have to make regarding frail patients is where we draw the line about looking for reversible causes and interventions,” he observed. “Long-term care facilities are well positioned to be involved in this because they have a big stake in [it].”