Inclusion of Older People in Trials

See related article, p 2737 .Upper age limits for randomized controlled trials for stroke (and other conditions) have been common. Reasons have included historical precedent, risk management by pharmaceutical companies, fears of unacceptable side effects, and practical issues of consent, recruitment, and follow-up. The FAST-MAG trial (Field Administration of Stroke Therapy-Magnesium) was no exception, but the age limit of 95 years provided an opportunity to study the effect of including older people (those aged ≥80 years) in this important trial of prehospital magnesium for stroke.1,2 Their results are important and illustrate some important aspects of modern stroke care.2 First, 29% of the trial population were aged ≥80 years, matching the epidemiology of stroke in developed nations.3,4 We cannot continue to exclude one-third of the people with the disease in question. Second, the baseline characteristics illustrate that older people were different from younger people in important clinical variables. They were more likely to be white and female (because of the longevity of this demographic) and had significant differences in risk factors. Fewer smokers (perhaps because of a …