Expanding Geroscience to Vulnerable Populations in mid-late life: Medicaid home- and community-based service users and formerly incarcerated individuals.

A wide range of geroscience-guided interventions, or gerotherapeutics, including repurposed drugs, natural products, and lifestyle changes are now being tested in small-scale proof-of-concept studies. If successful, these efforts may help maintain or restore function across numerous health-related domains, thus extending human healthspan. To date, little attention has been paid to exploring the potential of gerotherapeutics to improve healthspan-related outcomes in vulnerable populations that have accumulated experiences detrimental to health in adulthood and later life. We contend that two vulnerable populations that have been especially overlooked are mid-late life adults receiving Medicaid-funded home- and community-based services (HCBS), and previously incarcerated individuals. Published data on Medicaid HCBS users shows ample evidence of racial, ethnic, and health-related heterogeneity, with opportunities for gerotherapeutics to stop or slow the progression of disability. Previously incarcerated individuals show evidence of accelerated biological aging, leading to geriatric conditions and hospitalizations greater than among matched counterparts not experiencing incarceration. We present ethical, equity, and clinical trial design considerations relevant to these vulnerable populations, including the possibility of implementing co-design procedures that might make gerotherapeutic interventions more attractive to individuals in these populations. We also discuss advocacy and service-related networks that could be tapped to help enhance the recruitment of these vulnerable populations into gerotherapeutic clinical trials.