1.4 Management of patients who are at risk of falls
Falls are a major risk for many older people, but there is good evidence that the risks of falls and fractures can be reduced with a multifactorial approach. In order to tackle fracture risk in Parkinson’s, it is essential that a falls risk assessment is carried out.
In clinic, all patients should be asked about previous falls as this is a strong predictor of having a fall in the future. Identifying episodes of near falls is also important as they may precede/indicate the occurrence of future falls.
A thorough and systematic search should be performed to identify any modifiable factors that led to the patient falling and these should be proactively tackled (van der Marck et al, 2014). Interventions will include:
- optimisation of medication strategy
- programmes of physiotherapy or balance classes
- other generic factors such as visual assessment and modification of environmental factors
Further details of how these risk factors are tackled are beyond the scope of this section but readers are directed to Parkinson’s and falls: tips & resources from the Parkinson’s West Midlands Excellence Network [link please], which includes guidance and further resources.
All patients should have their bone health assessed and actively treated.
The approach to this is detailed in Fracture risk assessment in Section 3 and Treatment options for osteoporosis in Parkinson’s in Section 4.
1.3 What are the consequences of falls?