Older adults, including those with cognitive impairment, have been largely underrepresented in research. The National Institutes of Health released a research policy which aims to increase representation across the lifespan and targets traditionally underrepresented age groups, including older adults and children. Challenges in enrolling older adults, which may contribute to the lower recruitment rates, include concerns about safety and frailty or obtaining informed consent for subjects with cognitive impairment or dementia. In addition, many studies explicitly exclude subjects with cognitive impairment. This case will explore the problem of underrepresentation of older adults in research, review ethical considerations, and describe components of decision making capacity necessary to consent for research. Strategies to address challenges in obtaining informed consent if the subject lacks decision making capacity will be discussed.