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The Challenge to Be Inclusive and Diversify Our Aging Populations

  • Margarita Alegría
    Correspondence
    Send correspondence and reprint requests to Margarita Alegría, Ph.D., Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., 8th Floor, Suite 830, Boston, MA
    Affiliations
    Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA

    Department of Medicine, Harvard Medical School, Boston, MA

    Department of Psychiatry, Harvard Medical School, Boston, MA
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Published:September 09, 2021DOI:https://doi.org/10.1016/j.jagp.2021.09.002
      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,
      • Collins FS
      • Adams AB
      • Aklin C
      • et al.
      Affirming NIH's commitment to addressing structural racism in the biomedical research enterprise.
      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.

      National Academies of Sciences Engineering and Medicine, Reducing the impact of dementia in America: a decadal survey of the behavioral and social sciences, 2021, The National Academies Press, 1–298

      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.
      Administration on Aging
      2020 Profile of Older Americans, Administration for Community Living.
      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,
      • Forsat ND
      • Palmowski A
      • Palmowski Y
      • et al.
      Recruitment and retention of older people in clinical research: a systematic literature review.
      but could benefit from these interventions.
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