Preventing and Dealing with Falls

By Dr. Logan Waddell PT, DPT, GCS
Board Certified Geriatric Specialist
LSVT BIG certified therapist

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Have you had a fall? You are not alone; someone living with Parkinson’s disease has twice the risk of falling compared to their peers. In fact, several studies have revealed that 38% to 87% of parkinsonian patients experienced falls [1-4]. One meta-analysis showed the rate of recurrent falls over a three-month period was 57% among those patients who had reported a previous fall [5]. While some falls are “minor” others have lasting physical and mental effects. Being aware of contributing factors including motor symptoms, non-motor symptoms and environmental factors can help keep you safe and reduce your risk for falling. 

Environmental factors

Is your home safe? Making adjustments around the house may help prevent future falls. Ensure adequate lighting, uncluttered pathways and non-skid surfaces in areas such as the bathroom. 

Throughout the House

  • Keep walkways open and free of clutter

  • Remove throw rugs to prevent trips

  • Make sure rooms are well lit and install nightlights along walkways

  • Consider placing lines of tape on the floor between rooms if “freezing” at doorways is a problem

Bathroom

  • Install a hand-held shower head

  • Use a rubber-backed bath mat to help prevent slips and falls

  • Install a shower seat to conserve energy and reduce fall risk

  • Have grabs bars to assist in getting into and out of the shower or tub.

Motor Symptoms

Some of the primary motor symptoms of Parkinson’s disease including bradykinesia (slowness of movement), rigidity (stiffness), and postural instability contribute to the risk of falling. My patients often tell me on their initial evaluations that “once I lose my balance I just keep going until I fall.” This sensation of not being able to stop moving is associated with changes in center of gravity and impaired postural reflexes. Proper stretching and an exercise program can assist in minimizing center of gravity changes associated with forward posture. Postural reflexes (a complex set of movements automatically performed to prevent a fall) are diminished with aging and conditions such as Parkinson’s disease. These balance recovery strategies can be retrained to reduce falls by a licensed physical therapist. 

Non-motor Symptoms

While many people are familiar with the motor symptoms of Parkinson’s disease, the non-motor symptoms can also contribute to increased risk of falling. Non-motor symptoms may include orthostatic hypotension (low blood pressure when arising from sitting or lying down), sleep disturbances, constipation and urinary incontinence. 

Orthostatic hypotension

Orthostatic hypotension occurs in one third of people with Parkinson’s disease [6]. A medical professional can assess your blood pressure in sitting and standing to determine if you have orthostatic hypotension. Seek out a professional if you notice any of the following symptoms after standing: light-headedness, dizziness, weakness, fatigue, nausea, blurred vision, cognitive slowing, legs buckling, headache or neck pain radiating into the shoulders. Sometimes the drop in blood pressure can be severe enough to cause fainting and temporary loss of consciousness (syncope). Some strategies to reduce these symptoms include drinking more fluids, minimize or avoid drinking alcohol, stand up slowly and stand still when feeling dizzy, avoid standing still or laying flat for long periods, wearing elastic compression stockings and possible medication changes. 

Know your risk and make changes. A licensed physical therapist can complete a comprehensive evaluation to determine your fall risk and develop an individualized evidence based program to minimize your risk of falls and restore your balance. 

Dr. Waddell is the speaker for our next PD Edu session on July 17.

References:

  1. Gray P, Hildebrand K. Fall risk factors in Parkinson’s disease. Journal of Neuroscience Nursing. 2000;32(4):222–228.

  2. Ashburn A, Stack E, Pickering RM, Ward CD. Predicting fallers in a community-based sample of people with Parkinson’s disease. Gerontology. 2001;47(5):277–281.

  3. Balash Y, Peretz C, Leibovich G, Herman T, Hausdorff JM, Giladi N. Falls in outpatients with Parkinson’s disease: frequency, impact and identifying factors. Journal of Neurology. 2005;252(11):1310–1315.

  4. Hely MA, Reid WGJ, Adena MA, Halliday GM, Morris JGL. The Sydney multicenter study of Parkinson’s disease: the inevitability of dementia at 20 years. Movement Disorders. 2008;23(6):837–844. 

  5. Pickering RM, Grimbergen YAM, Rigney U, et al. A meta-analysis of six prospective studies of falling in Parkinson’s disease. Movement Disorders. 2007;22(13):1892–1900.