Table 1.

Possible Reasons for Excluding Cognitively Impaired Older Adults from Research Studies and Potential Alternatives

Reason	Examples	Potential Alternatives
Inability to consent to participate in research study	Patient has dementia or other cognitive impairment listed in medical history thus researchers automatically exclude patient.	Screen patient for decisional capacity before deciding to exclude. If there is time, try screening and assessing capacity at different times of the day to avoid the possible fluctuation of cognitive impairment. Ask the IRB prior to beginning the study for the option to allow for the appointment of a proxy if it is deemed the patient cannot consent for themselves.
Inability to follow intervention instructions	Patient has cognitive impairment and it is assumed he or she will not be able to follow the intervention instructions.	Ahead of time adapt intervention protocol and/or materials using plain language Use procedures such as corrective feedback and teach-back to ensure patient understands intervention
Inability to report outcomes	Patient has cognitive impairment and it is assumed he or she will not be able to complete follow-up assessments and report outcomes.	Ahead of time choose alternative outcome measures that have been adapted for cognitively impaired individuals such as the Bristol Activities of Daily Living Scale (Bucks, Ashworth, Wilcock, & Siegfried, 1996).