title: Attempts to reach the oldest and frailest: recruitment, adherence, and retention of urban elderly persons to a falls reduction exercise program.
abstract: OBJECTIVE
  To assess the recruitment, adherence, and retention of urban elderly, predominantly African Americans to a falls reduction exercise program.
  
  
  METHODS
  The randomized controlled trial was designed as an intervention development pilot study. The goal was to develop a culturally sensitive intervention for elderly persons who suffered a fall and visited an emergency department (ED). Participants were taught exercises during 4 on-site group classes and encouraged to continue exercising at home for 12 weeks and attend additional on-site monthly classes. The protocol included a specifically designed intervention for increasing retention through trained community interventionists drawn from the participants' neighborhoods.
  
  
  RESULTS
  The screening of 1,521 ED records after falling yielded the recruitment of 204 patients aged 65 years and older. Half were randomized into the falls prevention program. Of the 102 people in the intervention group, 92 completed the final 6-month assessment, 68 attended all on-site sessions, but only 1 reported exercising at home all 12 weeks. Those who lived alone were more likely (p = .03) and those with symptoms of depression were less likely (p = .05) to attend all on-site exercise classes. The final recruitment rate was estimated as 31.8%. The final retention rates were 90.2% and 87.3% for the intervention and control groups, respectively.
  
  
  CONCLUSIONS
  Recruitment of frail elderly African American patients is resource intensive. Adherence to the on-site exercise classes was better than to the home-based component of the program. These findings have implications for the design of future community-based exercise programs and trials.
authors.affiliation: Physical Medicine and Rehabilitation and Epidemiology, University of Pennsylvania, 904 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA. mstinema@exchange.upenn.edu
authors.forename: Margaret G
authors.initials: MG
authors.lastname: Stineman
authors.forename: Neville
authors.initials: N
authors.lastname: Strumpf
authors.forename: Jibby E
authors.initials: JE
authors.lastname: Kurichi
authors.forename: Jeremy
authors.initials: J
authors.lastname: Charles
authors.forename: Jeane Ann
authors.initials: JA
authors.lastname: Grisso
authors.forename: Ravishankar
authors.initials: R
authors.lastname: Jayadevappa
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005081:Exercise Therapy; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D010349:Patient Compliance; D018579:Patient Selection; D010809:Physical Fitness; D010865:Pilot Projects; D012307:Risk Factors; D016896:Treatment Outcome; D014505:Urban Population; D044465:White People