A randomized trial of exercise programs among older individuals living in two long-term care facilities: the FallsFREE program.

OBJECTIVE: To use two different exercise programs over a 2-year period to reduce falls and their sequelae among residents of two long-term care facilities. DESIGN: Randomized, controlled trial. SETTING: The study took place at two long-term care facilities with services ranging from independent living to skilled nursing. PARTICIPANTS: One hundred and ten participants whose average age was 84 and who were capable of ambulating with or without assistive devices and could follow simple directions. INTERVENTION: Participants were randomized to one of two exercise groups (resistance/endurance plus basic enhanced programming or tai chi plus basic enhanced programming) or to a control group (basic enhanced programming only). Exercise classes were held three times per week throughout the study. MEASUREMENTS: Participants were evaluated for cognitive and physical functioning at baseline and 6, 12, and 24 months. Falls were determined from incident reports filed by the nursing staffs at the facilities. RESULTS: Time to first fall, time to death, number of days hospitalized, and incidence of falls did not differ among the treatment and control groups (P>.05). Among all participants, those who fell had significantly lower baseline Folstein Mini-Mental State Examination and instrumental activities of daily living scores and experienced significantly greater declines in these measures over the 2-year program. CONCLUSION: There were no significant differences in falls among the two exercise groups and the control group. Lack of treatment differences and low adherence rates suggest that residents of long-term care facilities may require individualized exercise interventions that can be adapted to their changing needs.

Accuracy in estimating fasting blood glucose levels by patients with diabetes.

This study was designed to assess the accuracy with which diabetic patients can estimate their fasting blood sugars (FBS) and to determine whether experience with self-monitoring of blood glucose improves this ability. Twenty patients with type II diabetes who had no experience with self-monitoring of blood glucose were compared with 17 patients who had been monitoring blood sugar regularly for the previous 8 mo. All patients were asked to estimate FBS immediately before it was measured in the laboratory. Patients were very accurate in estimating their FBS; the average error in estimation was 2 mg/dl, and 65% of patients estimated FBS within 20% of actual FBS. However, there was no evidence that experience in self-monitoring of blood glucose improved the accuracy of estimation. Additional studies are needed to determine the types of cues that patients use in estimating blood sugar.