1.2 Why do people with Parkinson’s fall?
As with most older people who experience a fall, the majority of falls in Parkinson’s result from the interplay of a lot of factors. Some of these are generic (that is, they may affect people without Parkinson’s) whereas some are specific to, or much more common in, Parkinson’s.
Reflective exercise 1
Use your reflective log to draw a table similar to the following:
| Generic | Parkinson’s specific |
|
Then from the following list of risk factors for falls, place each factor into the correct column of your table:
| text list | text list |
|---|---|
| anticholinergics for tremor or bladder | age |
| antidepressant medication | anxiety |
| nocturia | history of previous falls |
| axial rigidity | high doses of levodopa |
| postural hypotension | difficulty with performing dual tasks |
| sedative medication | poor balance |
| inappropriate polypharmacy | cardiac arrhythmia |
| freezing of gait | abnormal posture |
| dyskinesia | muscle weakness |
| arthritis and joint problems | visual impairment |
| daily drinking of alcohol | environmental hazards |
| peripheral neuropathy | cognitive impairment |
Discussion
Your table should look like this:
| GENERIC | More common in or specific to Parkinson’s |
| history of previous falls | high doses of levodopa |
| age | anticholinergics for tremor or bladder |
| antidepressant medication | postural hypotension |
| inappropriate polypharmacy | freezing of gait |
| sedative medication | abnormal posture |
| cardiac arrhythmia | poor balance |
| arthritis and joint problems | nocturia |
| anxiety | difficulty with performing dual tasks |
| muscle weakness | axial rigidity |
| visual impairment | dyskinesia |
| daily drinking of alcohol | |
| environmental hazards | |
| peripheral neuropathy |
Parkinson’s is associated with distinct abnormalities in balance and gait.
Balance abnormalities include:
- abnormal posture
- increased sway
- inability to change sensory weighting
- reduced limit of stability
- altered postural strategies to perturbation
- abnormal anticipatory adjustments
It can be useful to classify gait abnormalities into two types. The first affects one footstep to the next, including:
- slower, more irregular walking
- asymmetry between left and right footsteps
The second type occurs episodically and can include:
- freezing episodes, in which patients describe their feet as being stuck to the floor like glue
- festination – whereby increasingly short steps are taken as the feet ‘run away’ with themselves
The intermittent, episodic and often unpredictable nature of gait freezing is a very strong risk factor for falling.
Medication and falls
Being on lots of prescribed medication (polypharmacy) is itself associated with an increased risk of falls. But some medications bring higher risks than others, probably through their effects on balance and cognition. Parkinson’s-specific medication can improve falls risk if it improves gait and balance, but it can also be associated with falls because of its potential negative effects on cognition and blood pressure.
Please complete the following quiz. This is formative. It is really helpful in consolidating your learning, but there is no pass mark:
1.1 Who falls with Parkinson’s?