Falls in outpatients with Parkinson’s disease: frequency, impact and identifying factors
Journal of Neurosurgery
Balash, Y., Peretz C., Leibovich G., Herman T., Hausdorff J.M., Giladi N. (2005) Falls in outpatients with Parkinson’s disease: frequency, impact and identifying factors Journal of Neurosurgery, 2005 Nov; 252(11):1310-5
These researchers wanted to look at frequency of falls and associated factors in patients with PD. They briefly reviewed why studying falls, a gait difficulty with serious complications (physical injury, fears, restriction of activities, and admission to nursing homes) for the patient with PD, is important. They reported that the frequency of falls in the literature is approximately 38-68% but that associated factors are not as well documented or understood. This study was conducted in the UK on 350 patients with PD (230 males, 120 females; mean age 69.7, duration of PD 8.6 years). The authors also looked at cognitive function, depression, general health, activities of daily living, balance, gait, and bladder dysfunction (they cited literature that showed urinary urge incontinence is associated with falls in older women). Patients were asked to count how many falls (those requiring and not requiring medical attention) they had in the previous week, month, and year. Thirty-two percent of the patients had 2 or more falls in the previous week, month, or year of the study. Additionally, 10.6% of patients had a fall that required medical attention (cut, fracture, and bleeding in the brain). The authors also found that urinary incontinence and duration of PD were the only significant predictors of falling. Additionally, they found that patients prone to falling had worse Hoehn and Yahr scores, depressive symptoms, lower activities of daily living, and identified their health as poorer. Additional statistics suggested that if a patient had PD and urinary incontinence, he/she was 6 times more likely to have repeated falls. Also, a slowed performance on a measure of gait and disease duration also suggested that patients were more likely to have repeated falls. The authors also discussed a limitation to their study including that it was retrospective (asking patients and carers to remember how many falls occurred over the last year may be difficult and inaccurate), which may have lowered the actual number of falls that individuals had. They cited a study suggesting patients tend to underreport the number of falls they’ve had, which suggests that the actual number of falls in their group may be higher than that reported. They also discussed that based on their data, falls are associated with progression of PD and may be due to the loss of postural reflexes and postural instability. They also encouraged medical professionals and family members to be aware that if a patient with PD has incontinence that they are more likely to have difficulties with falls and may require more fall precautions or associated therapies. They ended by suggesting continued study of medications, urinary incontinence, orthostatic hypotension, and autonomic dysfunction in regards to fall risks for patients with PD.