Wrist-worn voice recorders capture the circumstances and context of losses of balance among community-dwelling older adults.

BACKGROUND: Most falls among community-dwelling older adults are due to a loss of balance (LOB) after tripping or slipping. Unfortunately, limited insight is available on the detailed circumstances and context of these LOBs. Moreover, commonly used methods to collect this information is susceptible to limitations of memory recall. The goal of this pilot observational study was to explore the circumstances and context of self-reported LOBs captured by wrist-worn voice recorders among community-dwelling older adults. METHODS: In this pilot observational cohort study, 30 community-dwelling adults with a mean (SD) age of 71.8 (4.4) years were asked to wear a voice recorder on their wrist daily for 3 weeks. Following any naturally-occurring LOB, participants were asked to record their verbal responses to six questions regarding the circumstances and context of each LOB abbreviated with the mnemonic 4WHO: When, Where, What, Why, How, and Outcome. RESULTS: Participants wore the voice recorder 10.9 (0.6) hours per day for 20.7 (0.5) days. One hundred seventy-five voice recordings were collected, with 122 meeting our definition of a LOB. Each participant reported 0-23 LOBs over the 3 weeks or 1.4 (2.1) per participant per week. Across all participants, LOBs were most commonly reported 3 p.m. or later (42%), inside the home (39%), while walking (33%), resulting from a trip (54%), and having induced a stepping response to regain balance (48%). No LOBs resulted in a fall. CONCLUSIONS: Among community-dwelling older adults, wrist-worn voice recorders capture the circumstances and context of LOBs thereby facilitating the documentation of detail of LOBs and potentially falls, without reliance on later recall.

Development of an exercise therapy referral clinical support tool for patients with osteoporosis at risk for falls.

BACKGROUND: The purpose of this study was to develop a clinical support tool for osteoporosis clinic providers to support risk assessment and referrals for evidence-based exercise therapy programs. METHODS: A sequential Delphi method was used with a multidisciplinary group of national falls experts, to provide consensus on referral to exercise therapy for patients at risk for falls. The Delphi study included a primary research team, expert panel, and clinical partners to answer the questions: (1) "What patient characteristics are needed to develop a clinical support tool?"; (2) "What are the recommended exercise referrals for patients with osteoporosis at risk for falls?" The consensus process consisted of two rounds with 8 weeks between meetings. Two qualitative researchers analyzed the data using a modified version of a matrix analysis approach. RESULTS: The following were the most important variables to include when determining exercise therapy referrals for patients with osteoporosis: Patient history and demographics, falls history over the last year, current physical function and balance, caregiver and transportation status, socioeconomic and insurance status, and patient preference. Potential exercise therapy referrals included one-on-one physical therapy, group physical therapy, home health, community-based exercise programs, and not acceptable for exercise therapy. CONCLUSIONS: Patient characteristics including patient history, physical function and balance performance, socioeconomic and insurance status, and patient preference for exercise therapy are important to inform both the medical provider and patient with osteoporosis to choose the most appropriate exercise therapy referral. Adoption of the algorithmic suggestions may have a significant impact on uptake and adherence to exercise therapy, ultimately improving patient physical function and reducing falls risk.

High habitat richness reduces the risk of tick-borne encephalitis in Europe: A multi-scale study.

Background: The natural transmission cycle of tick-borne encephalitis (TBE) virus is enhanced by complex interactions between ticks and key hosts strongly connected to habitat characteristics. The diversity of wildlife host species and their relative abundance is known to affect transmission of tick-borne diseases. Therefore, in the current context of global biodiversity loss, we explored the relationship between habitat richness and the pattern of human TBE cases in Europe to assess biodiversity's role in disease risk mitigation. Methods: We assessed human TBE case distribution across 879 European regions using official epidemiological data reported to The European Surveillance System (TESSy) between 2017 and 2021 from 15 countries. We explored the relationship between TBE presence and the habitat richness index (HRI1) by means of binomial regression. We validated our findings at local scale using data collected between 2017 and 2021 in 227 municipalities located in Trento and Belluno provinces, two known TBE foci in northern Italy. Findings: Our results showed a significant parabolic effect of HRI on the probability of presence of human TBE cases in the European regions included in our dataset, and a significant, negative effect of HRI on the local presence of TBE in northern Italy. At both spatial scales, TBE risk decreases in areas with higher values of HRI. Interpretation: To our knowledge, no efforts have yet been made to explore the relationship between biodiversity and TBE risk, probably due to the scarcity of high-resolution, large-scale data about the abundance or density of critical host species. Hence, in this study we considered habitat richness as proxy for vertebrate host diversity. The results suggest that in highly diverse habitats TBE risk decreases. Hence, biodiversity loss could enhance TBE risk for both humans and wildlife. This association is relevant to support the hypothesis that the maintenance of highly diverse ecosystems mitigates disease risk.