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Research plays a strong role in the development of treatment plans and policies in health care. Thus, participants of all ages and each gender need to be included in research projects. Participation of older adults in research is especially important because the U.S. Census Bureau (2001) indicated a 12% increase in individuals age 65 and older since 1990. Further, projections indicate that by the year 2030 there will be more than 69 million adults 65 years and older, with those 85 years and older making up the fastest growing portion of the population (Administration on Aging, n.d.; Mazzeo et al., 1998). As a result of increased longevity, the population of older adults with one or more chronic diseases will increase as well. This population will become the major consumer of health care. Therefore, the health care community needs more information about what treatments are most efficacious for older adults - especially because they, historically, have been excluded from research because of such factors as coexisting illnesses (Gurwitz, Col, & Avorn, 1992). Even when researchers have attempted to include this population, older adults frequently have chosen not to partieipate. This unwillingness may be related to the informed consent process or their lack of understanding of research.
The informed consent process is built on the three ethical principles - respect for individuals, beneficence, and justice - defined in "The Belmont Report" (The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1979). The purpose of informed consent, according to current guidelines, is to protect and allow individuals to make informed, autonomous choices about participation in research. Yet, this process may simultaneously exclude important populations such as older adults and limit the generaUzability of research results. Therefore, the purpose of this article is to review the informed consent process, identify barriers to the process, and propose changes to facilitate older adults' participation in research.
CONSENT PROCESS
Beauchamp and Childress (1994) conceptualized the consenting process as ongoing, rather than a one-time, event. They propose three distinct elements or stages of the consent process:
* Threshold.
* Information.
* Consent.
Each of these stages offers unique opportunities to facilitate participation in research while protecting the rights of the older adult.
Threshold Stage
The threshold stage encompasses...