INCLUSION OF ETHNICALLY DIVERSE POPULATIONS IN CLINICAL TRIALS OF HEALTHSPAN: IMPLICATIONS FROM THE SALSA STUDY

Abstract Background Geroscience-guided clinical trials focused on healthspan may seek to enroll older adults initially free of chronic diseases and disability. Here we examine healthspan in the San Antonio Longitudinal Study of Aging (SALSA), a cohort of 749 community-dwelling older (65+ years) Mexican Americans (MA) and European Americans (EA), and describe prevalence and characteristics associated with poor healthspan. Methods Poor healthspan was defined at the SALSA baseline exam as presence of any one of: 1) chronic disease (diabetes, myocardial infarction, congestive heart failure, stroke, chronic obstructive pulmonary disease, or cancer); 2) dependence in basic or instrumental activities of daily living; or 3) mini mental state exam score < 18. Frailty was defined by Fried phenotype criteria. The association of poor healthspan with age, sex, ethnic group, socioeconomic status (SES), and frailty was assessed using chi-square or t-tests. Results 544 (72.6%) participants met criteria for poor healthspan, which was associated with older age (69.6 ±3.4 vs. 69.3 ±3.4, p< 0.05), male sex (77.3% vs. 69.2%, p< 0.05), MA ethnicity (77.4% vs. 67.3%, p< 0.05), lower income (11.3 ±3.1 vs. 12.2 ±2.9, p< 0.001 and education (10.4 ±4.6 vs. 12.7 ±3.2, < 0.0001), and frailty (95.5% vs. 4.6%, p< 0.001). Conclusion Poor healthspan was highly prevalent (>70%) in SALSA and associated with MA ethnicity, low SES, and frailty. Geroscience-guided clinical trials of potential interventions to improve healthspan by preventing chronic diseases and disability may under-represent individuals of ethnic minority background and lower SES and, thereby, jeopardize generalizability of the findings to the broader population.


CROSS-CULTURAL DIFFERENCES IN AGE ESTIMATION AND AGE
Our society is aging rapidly with older adults composing a continuously growing proportion of the population.This expected shift in population age is likely going to carry societal consequences, such as an increase in age discrimination.Previous research has shown that ageism (the systematic stereotyping and categorizing of people based on their age) is the most experienced kind of prejudice across Europe, with individualistic, industrialized countries like the USA and Germany showing greater levels of age bias towards the elderly.The current study aimed to investigate cross-cultural differences in age estimation and attitudes towards older adults.Pilot measures included 102 participants (65 American, 37 German) who estimated the age of 12 male celebrities representing three different age groups (young, middle, and older adult) and completed the Fraboni Scale of Ageism (FSA), a survey measurement investigating ageism.Although the Fraboni scale has been validated in other countries, it has not yet been translated to German, nor tested on a primarily German-speaking population.Preliminary analyses showed that both the original FSA scale and the German translation were reliable (αOriginal = 0.909, αGerman = 0.703), however, t-test revealed significant differences between the FSA mean scores of the original scale (M = 1.78,SD = .34)and the translated version (M = 3.15, SD = .28),t(100) = -20.90,p < .001.The researchers are currently recruiting 400 additional participants to explore the effects of culture, race, and participant age on age estimation and further validate the German translation of the scale.

INCLUSION OF ETHNICALLY DIVERSE POPULATIONS IN CLINICAL TRIALS OF HEALTHSPAN: IMPLICATIONS FROM THE SALSA STUDY
Sara Espinoza, Tiffany Cortes, and Helen Hazuda, UT Health San Antonio, San Antonio, Texas, United States Background: Geroscience-guided clinical trials focused on healthspan may seek to enroll older adults initially free of chronic diseases and disability.Here we examine healthspan in the San Antonio Longitudinal Study of Aging (SALSA), a cohort of 749 community-dwelling older (65+ years) Mexican Americans (MA) and European Americans (EA), and describe prevalence and characteristics associated with poor healthspan.
Methods: Poor healthspan was defined at the SALSA baseline exam as presence of any one of: 1) chronic disease (diabetes, myocardial infarction, congestive heart failure, stroke, chronic obstructive pulmonary disease, or cancer); 2) dependence in basic or instrumental activities of daily living; or 3) mini mental state exam score < 18. Frailty was defined by Fried phenotype criteria.The association of poor healthspan with age, sex, ethnic group, socioeconomic status (SES), and frailty was assessed using chi-square or t-tests.
Conclusion: Poor healthspan was highly prevalent (>70%) in SALSA and associated with MA ethnicity, low SES, and frailty.Geroscience-guided clinical trials of potential interventions to improve healthspan by preventing chronic diseases and disability may under-represent individuals of ethnic minority background and lower SES and, thereby, jeopardize generalizability of the findings to the broader population.Over 50% of patients in intermediate care units (IMCU) present with multimorbidity, two or more chronic conditions.Balancing the effects of multimorbidity and their treatments with quality-of-life can be a challenge.This experience-based co-design project aimed to elicit experiences of patients, family caregivers, and healthcare professionals in IMCU, in the context of challenges and intricacies of multimorbidity management, to inform the development of a symptom management toolkit.Patients aged 55 years and older were recruited and interviewed in person.Healthcare professionals working in IMCU (i.e., physicians, nurses, respiratory therapists, social workers, etc.) were recruited and interviewed virtually.Participants were asked questions about their role in recognizing and treating symptoms, factors affecting quality of life, symptom burden and trajectory over time, and symptom management strategies that have and have not worked.An inductive thematic analysis approach was used for data analysis.Twenty-three interviews were conducted: 9 patients, 2 family-caregivers, and 12 healthcare professionals.Patients' mean age was 67.5 (± 6.5) years, over half (n=5) were Black or Hispanic, and average number of multimorbidity was 3.67.Five major themes emerged: 1) importance of patient-provider relationship; 2) open and honest communication; 3) accessibility of resources during hospitalization and at discharge; 4) caregiver support, training, and education; and 5) carecoordination and follow-up care.Patients, caregivers, and healthcare professionals often have different priorities for multimorbidity management, treatment, and education.However, given the growing population of patients experiencing multimorbidity, it is imperative to identify shared priorities and target holistic interventions considering their experiences to enhance outcomes.

PATIENT PARTICIPATION IN HEALTHCARE ACTIVITIES: NURSES' AND PATIENTS' PERSPECTIVES IN TAIWAN
Hsueh-Fen Kao 1 , Chang-Chiao Hung 2 , Bih-O Lee 3 , Su-Ling Tsai 2 , and Oscar Moreno 4 , 1.The University of Texas at El Paso, El Paso, Texas, United States, 2. Chung-Gung University of Science and Technology, Puzi City, Chiayi, Taiwan (Republic of China), 3. Kaohsiung Medical University, Kaohsiung, Kaohsiung, Taiwan (Republic of China), 4. M B Care Home Health, LLC, El Paso, Texas, United States Patient participation in healthcare activities is key to producing successful patient-centered care.However, little is known about both nurses' and patients' perspectives regarding patient participation in East Asia.This paper compared and contrasted perspectives of patient participation in healthcare activities between nurses and patients (age=61.53±8.75), using a qualitative study with a purposive sample of 39 nurses and 15 patients.Inclusion criteria for patient participants were: (1) speaking Mandarin Chinese or Taiwanese dialect, (2) aged 20 or older, (3) hospitalized at the unit for at least 3 days, (4) able to provide written informed consent, and (5) well enough to endure 40-50 minutes of individual interview.A semi-structured interview was applied to focus groups for nurses, and to face-to-face interviews for patients to prevent nosocomial infection.Content analysis was utilized to analyze the data, common themes and subthemes were identified showing three similarities in perspectives between nurses and patients-authoritative culture, participation behaviors, and obstacles to participation, as well as two differences-sources of acquiring patient-related health information, and responsible party.Nurses and patients did not entirely view participation in healthcare activities congruently.Relevant clinical practices are also suggested, including respecting patients' autonomy, nurses' using layman's language for explanations, patients' understanding the meaning behind their participation behaviors, recognizing obstacles faced in enhancing patient participation with adjusted nursing workload, actively providing needed health information, and leading patients to realize that they will be responsible for their health behaviors after discharge.

PLACE-BASED HEALTH DISPARITIES: FUNCTIONAL DISABILITY IN APPALACHIAN WEST VIRGINIA
Carly Pullen, Kareem Ibrahim-Bacha, and Julie Hicks Patrick, West Virginia University, Morgantown, West Virginia, United States Place-based health disparities contribute to disability across the lifespan.Additional examinations of contributors to morbidity and disability at mid-and late-life are needed to inform policies and programs.Using data from the 2020 Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS), we examine some of the social determinants of health (e.g., age, gender, education, income) as predictors of access to health care and predictors of functional ability.The study included 5,880 adults living in Anna Peeler 1 , Katie Nelson 2 , Sarah Badawi 2 , Lara Street 3 , David Hager 3 , Patricia Davidson 4 , and Binu Koirala 2 , 1. Johns Hopkins University School of Nursing, Baltimore, Maryland, United States, 2. Johns Hopkins University, Baltimore, Maryland, United States, 3. Johns Hopkins Hospital, Baltimore, Maryland, United States, 4. University of Wollongong, Wollongong, New South Wales, Australia