operative research between agencies or organizations is also difficult, if not impossible, since different IRBs often take different positions on these issues, including what information must be disclosed to obtain informed consent.

As a first step in this direction, the panel has sought to clarify some of the issues in these two areas and to provide some needed guidance. Eventually, the National Institute on Aging, in collaboration with the Office for Human Research Protections and other federal partners, should take the lead to promote further clarification, thereby helping investigators and IRBs to achieve the proper level of participant protection while enabling important research involving older and vulnerable adults to move forward. In addition, NIH should continue to support research on assessing decisional impairments and the adequacy of participant consent, on the effects of interventions aiming to facilitate and sustain consent by subjects with impairments, and on the nature and consequences of investigator and IRB responses to disclosures of mistreatment during the course of a study.

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