The Challenge to Be Inclusive and Diversify Our Aging Populations

Inclusion and diversity in clinical trials has become a more pressing mantra than ever before. It is a key component of the National Institutes of Health's approach to ending structural racism in biomedical research, and it also represents a call to expand who is included in our clinical trials as to not limit the relevance of scientific findings. Representation of participants of adversely affected communities is critical for preventive care and for meeting the complex health needs of older adults. But many aspects of their lives have not been prioritized in the design of typical recruitment procedures, such as disability, frailty, limited mobility, limited English proficiency, rurality, or health literacy. It is especially urgent considering that adults 65 and older are becoming increasingly diverse and older frail participants are living longer, with opportunities to benefit from the results of clinical trials. For example, between 2019 and 2040, a growing number of non-White older adults (65+ years) are projected to dramatically increase, including those categorized as Latinx (161%), African American (80%), American Indian and Alaska Native (67%), and Asian American (102%) compared to only 29% of the predicted growth among the non-Hispanic white population. If the results of interventions are to be generalizable to most of the population of older adults, it is paramount to know what research strategies can effectively include older diverse, frail or disabled adults who appear to have been erased from the scientific literature, but could benefit from these interventions.