British Medical journal
BMJ
Editor's Choice
Wellbeing—for patients and doctors
BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l1156 (Published 14 March 2019)
Cite this as: BMJ 2019;364:l1156
Rapid response
Parkinson disease and falls
Falls are a problem for patients and their physicians in many ways.
People living with Parkinson’s disease (PD) are at a higher risk of falls due to the motor symptoms, including stiff muscles, freezing and balance impairment.
Patients with PD are at twice the risk of falling. Falls can be mild to severe. They may result in increased disability and a reduced quality of life. The fear of falling in people living with PD is real and affects both the patient and their caregiver or care partner like a doctor or physiotherapist.
Factors such as a longer disease duration, higher levodopa doses, stooped posture, balance problems, impaired gait, freezing episodes and cases of “on” time dyskinesia increase the risk of falls.
Patients with Parkinson disease, those taking antidepressants or antipsychotic medications (with sedative effects), those who have cognitive impairment such as difficulty with multitasking, switching tasks, or solving problems, those who experience sleep disturbances, particularly REM sleep disorder and those with vision impairments, such as blurry vision or the inability to recognize changes in depth perception, are also at increased risk of falls.
There are many ways of reducing the risk of falling in Parkinson disease.
1.Talk to the treating doctor about the risks.
A doctor can assess patients' personal risk and can help to manage the medications and their side effects. Medications may need to be adjusted or switched up.
2. Exercise regularly to help maintain strength, improve stamina, improve balance, and reduce the risk of falls in PD.
Exercises that challenge your balance are especially beneficial, and research has shown that exercise that requires a patient's attention, concentration and focus on activity and movement may also be neuroprotective – protecting the nerve cells from damage and possibly slowing the progression of PD.
3. Make modifications of the patient's home.
There are several adaptations that can be made in a patient's home to make falls less likely, such as removing throw rugs, ensuring wide pathways through furniture, and adding non-skid mats and grab bars to showers and bathtubs.
4. Use a walking aid.
Canes or four-wheeled walkers offer stability for people with PD
5. Learn ways to overcome freezing episodes, such as walking in beat to music or a metronome.
Some people also find it helpful to move from side to side before stepping forward.
6. Work with a physical therapist or occupational therapist.
Physical and occupational therapists can provide exercises to help keep patients with PD mobile. Occupational therapists can also suggest adaptations and modifications to the person’s environment.
Competing interests: No competing interests
17 March 2019
M.A. Aleem
Emeritus Professor of Neurology * Visiting Specialist in Neurology ** Consultant Neurologist ***
A.M.Hakkim
The Tamilnadu Dr.M.G.R. Medical University * Dhanalakshami Srinivasan Medical College ** ABC Hospital ***
Chennai 600032* Perambalure 621212** Trichy 620018*** Tamilnadu India
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