Introduction: Older adults can be difficult to recruit for research studies in the intensive care unit (ICU). Our objective was to evaluate consent rates in a study of older ICU survivors in which consent was obtained during the ICU hospitalization, analyze barriers to consent, and describe strategies to address these challenges and increase consent rates. Methods: The LANTERN study is a longitudinal study in which older adults are approached for consent during their ICU stay. Participants complete an in-hospital interview, a home visit, and 6 monthly follow-up calls. We identified 1,053 potential participants between 1/2024-7/2025. Outcomes included “consented” or “not consented,” with the latter category further divided into “refused,” “approached, but patient/proxy did not consent before discharge,” and “missed (not approached).” We described demographic characteristics by outcome category using means and standard deviations for continuous variables and proportions for categorical variables. Reasons for refusing consent were qualitatively analyzed. Modifiable barriers to consent were identified, and strategies were generated to address them. Results: The mean (standard deviation SD) age was 76.5 (7.3) years, 567 (54%) were female, and 161 (15%) identified as Black. Of 1,053 eligible patients, 351 consented, 458 refused, 201 were approached but did not consent before discharge, and 43 were missed. Reasons for refusal were grouped into 15 categories; the three most common were lack of interest (n=116, 25.3%), too much going on/feeling overwhelmed (n=100, 21.8%), and medical reasons, such as poor prognosis or feeling too tired (n=68, 14.8%). Among these, modifiable reasons included missing patients, concerns about the home visit, and feeling too tired. Strategies to improve consent rates included hiring more staff, offering phone visits in lieu of home visits, and approaching patients closer to discharge. In the first half of 2025, we consented an average of 25 patients/month compared to 15 patients/month in 2024. Conclusions: We found that critically ill older adults face several barriers to research participation, including modifiable factors which may be addressed with flexibility in follow-up and timing of approach. These findings may help inform strategies for recruitment and future study design.
Fischer et al. (Sun,) studied this question.