***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
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    Input: Background Public health monitoring depends on valid health and disability estimates in the population 65 + years . This is hampered by high non-participation rates in this age group . There is limited insight into size and direction of potential baseline selection bias . Methods We analyzed baseline non-participation in a register-based r and om sample of 1481 inner-city residents 65 + years , invited to a health examination survey according to demographics available for the entire sample , self-report information as available and reasons for non-participation . One year after recruitment , non-responders were revisited to assess their reasons . Results Five groups defined by participation status were differentiated : participants ( N = 299 ) , persons who had died or moved ( N = 173 ) , those who declined participation , but answered a short question naire ( N = 384 ) , those who declined participation and the short question naire ( N = 324 ) , and non-responders ( N = 301 ) . The results confirm substantial baseline selection bias with significant underrepresentation of persons 85 + years , persons in residential care or from disadvantaged neighborhoods , with lower education , foreign citizenship , or lower health-related quality of life . Finally , reasons for non-participation could be identified for 78 % of all non- participants , including 183 non-responders . Conclusion A diversity in health problems and barriers to participation exists among non- participants . Innovative study design s are needed for public health monitoring in aging population This systematic review examines the effectiveness of current exercise interventions for the management of frailty . Eight electronic data bases were search ed for r and omized controlled trials that identified their participants as “ frail ” either in the title , abstract , and /or text and included exercise as an independent component of the intervention . Three of the 47 included studies utilized a vali date d definition of frailty to categorize participants . Emerging evidence suggests that exercise  has a positive impact on some physical determinants and on all functional ability outcomes reported in this systematic review . Exercise programs that optimize the health of frail older adults seem to be different from those recommended for healthy older adults . There was a paucity of evidence to characterize the most beneficial exercise program for this population . However , multicomponent training interventions , of long duration ( ≥5 months ) , performed three times per week , for 30–45 minutes per session , generally had superior outcomes than other exercise programs . In conclusion , structured exercise training seems to have a positive impact on frail older adults and may be used for the management of frailty PURPOSE This article review s the problems associated with recruiting older minorities into mental health research studies and proposes a consumer-centered model of research methodology that addresses the barriers to recruitment and retention in this population . DESIGN AND METHODS The authors discuss and compare the results of  recruitment and retention interventions for two geriatric mental health studies , one that used traditional methods of recruitment and retention and another that used consumer-centered methods . RESULTS Although the consumer-centered methods result in better recruitment of older minorities in general ( chi(2 ) = 54.90 , p < .001 ) , it was not superior to the traditional method in recruiting older minorities ( chi(2 ) = 0.82 , ns ) . However , the consumer-centered approach yielded better retention of older minorities ( chi(2 ) = 6.20 , p < .05 ) than did the traditional method . Within both methods , recruitment through provider referral and face-to-face contact were the superior recruitment methods ( chi(2 ) = 6.78 , p < .05 ) . Having an experienced recruiter or a community recruiter result ed in greater agreement to participate than simply having an ethnically matched recruiter ( chi(2 ) = 36.00 , p < .001 ) . IMPLICATION S Although these data are observational , and rigorous research on the best methods for recruiting and retaining older minorities is still necessary , the results suggest that a consumer-centered model of research yields greater overall recruitment and retention rates than do traditional research methods The purpose of this study was to document predictors of long-term retention among minority participants in the Well Elderly 2 Study , a r and omized controlled trial of a lifestyle intervention for community-dwelling older adults . The primary sample included 149 African American and 92 Hispanic men and women aged 60 to 95 years , recruited at senior activity centers and senior residences . Chi-square and logistic regression procedures were undertaken to examine study -based , psychosocial and health-related predictors of retention at 18 months following study entry . For both African Americans and Hispanics , intervention adherence was the strongest predictor . Retention was also related to high active coping and average ( vs. high or low ) levels of activity participation among African Americans and high social network strength among Hispanics . The results suggest that improved knowledge of the predictors of retention among minority elders can spawn new retention strategies that can be applied at individual , subgroup , and sample -wide levels INTRODUCTION The purpose of this article is to examine the effectiveness of recruitment strategies  used to recruit African-American older adults for a senior center-based health promotion trial with a 6-month exercise component . METHODS We compared multiple strategies for recruiting participants from senior center members and other older adults residing in the surrounding predominantly African-American community . The phonathon , direct telephone recruitment by senior center leadership , is compared with traditional approaches . RESULTS All recruiting strategies combined yielded a total of 120 participants .  Phonathons involving five or six senior center board members in two half-day sessions yielded 40 participants or 33 % of all participants . Strategies categorized as printed media yielded 39 participants or 33 % of all participants . Strategies categorized as word-of-mouth yielded 31 participants or 26 % of all participants . Remaining approaches accounted for an additional 10 participants or 8 % of all participants . CONCLUSIONS Our results support employing a multifaceted recruitment approach and demonstrate the importance of strong linkages between the research team and community leaders in conducting health promotion research in minority communities . An innovative approach , the phonathon , may be a potentially important recruitment strategy Purpose . Identify the influence of medical mistrust , fears , attitudes , and sociodemographic characteristics on unwillingness to participate in colorectal cancer ( CRC ) screening .  Design . Cross-sectional , disproportionally allocated , stratified , r and  om-digit-dial telephone question naire of noninstitutionalized households . Setting . New York City , New York ; Baltimore , Maryl and ; San Juan , Puerto Rico . Subjects . Ethnically diverse sample of 454 adults ≥50 years of age . Measures . Health status , cancer screening effectiveness , psychosocial factors ( e.g. , perceptions of pain , fear , trust ) , and CRC screening intentions using the Cancer Screening Question naire , which addresses a range of issues related to willingness of minorities to participate in cancer screening . Analysis . Multivariate logistic regression was used to model the probability of reporting unwillingness to participate in CRC screening . Results . Fear of embarrassment during screening ( odds ratio [ OR ] = 10.72 ; 95 % confidence interval [ CI ] , 2.15–53.39 ) , fear of getting AIDS ( OR = 8.75 ; 95 % CI , 2.48–30.86 ) , fear that exam might be painful ( OR = 3.43 ; 95 % CI , 1.03–11.35 ) , and older age ( OR = 1.10 ; 95 % CI , 1.04–1.17 ) were positively associated with unwillingness to participate in CRC screening .  Fear of developing cancer ( OR = .12 ; 95 % CI , .03–.57 ) and medical mistrust ( OR = .19 ; 95 % CI , .06–.60 ) were negatively associated with unwillingness to screen . Conclusions . Findings suggest that CRC health initiatives should focus on increasing knowledge , addressing fears and mistrust , and normalizing CRC screening as a beneficial preventive practice , and should increase focus on older adults BACKGROUND The health status of people with intellectual disability ( ID ) is poor , yet very little research has been done on their health needs . There are several barriers to performing this research . The aim of our research was to examine the significant barriers encountered in recruiting adults with ID to participate in research . METHODS Our project was a r and omized controlled trial aim ing to improve health advocacy of people with ID . We approached many organizations to recruit participants and kept records of our results . Recruitment was very low for the first 4 months . Then we adopted two new recruitment strategies -- in-service telephone recruitment and meetings with prospect i ve participants . We then monitored the subsequent recruitment rates . We also question ed participants about the difficulties they encountered when considering recruitment . RESULTS Initial recruitment of participants yielded less than one-third of the expected number . Additional strategies implemented were partially successful . Significant barriers to recruitment included several sectoral issues and the challenges arising from the research process . CONCLUSIONS While this population is a difficult one to reach for research , attempts to do so should not be ab and oned , because the potential health benefits for this underserved group far outweigh the recruitment barriers experienced BACKGROUND Minority population s in the United States , especially blacks and Hispanics , are generally underrepresented among participants in clinical trials . Here , we report the experience of enrolling ethnic minorities in a large cancer screening trial . METHODS The  Prostate , Colorectal , Lung and Ovarian ( PLCO  ) Cancer Screening Trial is a multicenter r and omized trial design ed to evaluate the effectiveness of screening for the PLCO cancers . Subjects were recruited at 10 U.S. centers between 1993 and 2001 . One screening center had a major special recruitment effort for blacks  and another center had a major special recruitment effort for Hispanics .  RESULTS Among almost 155,000 subjects enrolled in PLCO , minority enrollment was as follows : black ( 5.0 % ) , Hispanic ( 1.8 % ) and Asian ( 3.6 % ) . This compares to an age-eligible population in the combined catchment areas of the PLCO centers that was 14.0 % black , 2.9 % Hispanic and 5.4 % Asian , and an age-eligible population across the U.S. that was 9.5 % black , 6.5 % Hispanic and 3.0 % Asian . About half ( 45 % ) of Hispanics were recruited at the center with the special Hispanic recruitment effort . Seventy percent of blacks were recruited  at two centers ; the one with the major special recruitment effort and a center in Detroit whose catchment area was 20 % black among age-eligibles . Blacks , Hispanics and ( non-Hispanic ) whites were all more highly educated , less likely to currently smoke and more likely to get regular exercise than their counterparts in the general population . CONCLUSION Significant efforts were made to recruit racial/ ethnic minorities into PLCO , and these efforts result ed in enrollment levels that were comparable to those seen in many recent cancer screening or prevention trials . Blacks and Hispanics were nonetheless underrepresented in PLCO compared to their levels among age-eligibles in the overall U.S. population or in the aggregate PLCO catchment areas OBJECTIVES Recruitment for r and omised clinical trials and community-based studies has received little attention in the dental literature . The goal of this study was to report on our experiences with  direct and indirect recruitment methods  for a trial to prevent  tooth loss in elders . METHODS A direct approach , consisting of an introductory lecture with the help of a local contact person in each of the nine community centres  , result ed in 208 recruits mostly from minority non-English speaking communities ( 52 % ) , whereas the other 192 recruits who responded to newspaper announcements ( 48 % ) were , in large part , from the English-speaking community . RESULTS The response suggests that a more direct and culturally specific approach is more productive when recruiting elders from ethnic minority groups , whereas elders from the dominant culture can be recruited indirectly and for about half the financial cost through newspaper announcements . CONCLUSION We conclude , therefore , that both direct and indirect methods are needed to recruit a multiethnic sample of subjects for a trial AIM The aim of this study was to explore the factors that contribute to health promotion in the oldest old and the barriers that prevent it . METHOD A non-r and om sample ( n = 52 ) of people aged 80 and older participated in a descriptive correlational study . Respondents completed a series of two Likert-type question naires . The  Health Promoting Lifestyle Profile II  ( Walker et al 1995 ) and  Barriers to Health Promoting Activities  for Disabled Persons Scale ( Becker et al 1991 ) were used to measure health behaviours . RESULTS Differences were noted between the age groups ( 80 - 90 and 91 - 101 ) for health responsibility , physical activity and nutrition . Impairment was the major barrier to health promotion . CONCLUSION To foster optimal living , the health , illness , function and motivation as well as age of older adults must be considered . They should be encouraged to pursue physical , social and intellectual activity , which can enable them to have active and fulfilling lives PURPOSE OF THE STUDY To assess the recruitment , adherence , and retention of urban elderly , predominantly African Americans to a falls reduction exercise program .  DESIGN AND METHODS The r and omized controlled trial was design ed 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 design ed intervention for 
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Across all groups , barriers for engagement were deteriorating health , having other priorities and lack of transport/inaccessibility .
Feeling too tired and lacking support from family members were additional barriers for the oldest old .
Similarly , feeling too tired and too old to participate in research on health promotion were reported by BME groups .
Barriers for BME groups included lack of motivation and self-confidence , and cultural and language differences .
Conclusions This review identified facilitators , barriers and strategies for engaging ‘ hard to reach ’ older people in health promotion but research has been mainly descriptive and there was no high quality evidence on the effectiveness of different approaches