Why Do Parkinson’s Patients Fall

Ways To Reduce The Risk Of Falling

There are several steps people living with PD can take to reduce their risk of falling, including:

• Talk to your doctor about your risks. Your doctor can assess your personal risk and can help you manage your medications and any side effects. Medications may need to be adjusted or switched up.
• Exercising regularly helps maintain strength, improve stamina, improve balance, and reduce the risk of falls. Exercises that challenge your balance are especially beneficial, and research has shown that exercise that requires your 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.
• Make modifications to your home. There are several adaptations that can be made in your 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.
• Use a walking aid.Canes or four-wheeled walkers offer stability for people with PD.
• 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.
• Work with a physical therapist or occupational therapist.Physical and occupational therapists can provide exercises to help keep you mobile. Occupational therapists also can suggest adaptations and modifications to the persons environment.1,3-5

Study Cohort Demographics And Clinical Assessments

The ABC-PD study was approved by the ethics committee of the Medical Faculty of the University of Tübingen and was performed in accordance with the ethical standards outlined in the 1964 Declaration of Helsinki and its later amendments.

We obtained informed consent from 55 PD patients prior to enrolment. All of the patients fulfilled the following inclusion criteria: 5085 years of age, diagnosis of PD according to the UK Brain-Bank criteria, and an ability to communicate well with the investigator and to understand and comply with the requirements of the study. Dementia served as an exclusion criterion . Forty-three subjects were included in the lab-based substudy, and 40 subjects were included in the home-based evaluation. Twenty-eight of the participants contributed to both substudies, which allowed us to intra-individually compare lab-collected turning parameters with those collected at home .

TABLE 1.Demographic, clinical, and iTUG data in the lab assessment.

TABLE 2. Demographic, clinical, and quantitative turning data in the home assessment.

TABLE 3. Ratio of turning parameters in the home versus the lab assessment.

Patients in the lab-based assessment were measured during their medication ON phase, i.e., during the study participants perception of having a good on phase after regular intake of medication .

Person Delivering The Intervention And Intervention Setting

The person delivering the intervention and intervention setting were not regularly reported in included systematic reviews. Of those presenting the person delivering the intervention, physiotherapists were most common, other disciplines included occupational therapists, yoga instructors, Tai Chi instructors, optometrists and multi-disciplinary teams. Interventions were primarily delivered in the community or the participants homes, but other settings including rehabilitation centres, hospitals and acute care were also reported.

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When Should I See My Healthcare Provider Or When Should I Seek Care

You should see your healthcare provider as recommended, or if you notice changes in your symptoms or the effectiveness of your medication. Adjustments to medications and dosages can make a huge difference in how Parkinsons affects your life.

When should I go to ER?

Your healthcare provider can give you guidance and information on signs or symptoms that mean you should go to the hospital or seek medical care. In general, you should seek care if you fall, especially when you lose consciousness or might have an injury to your head, neck, chest, back or abdomen.

Inclusion And Exclusion Criteria

Quantitative systematic reviews , mixed-methods systematic reviews , or pooled analyses and research syntheses investigating the effectiveness of non-pharmacological falls prevention interventions for people with MS, PD and stroke were considered for inclusion in this umbrella review. Reviews published in the English language were included and authors of potentially relevant reviews published in a different language were contacted to ascertain if a copy of the review was available in English. No restriction was placed on year of publication of the review. In instances where a systematic review was an update of a previous review, the most recent version was included and the older version excluded. For the purposes of this umbrella review, a review was classified as an update of a previous version if there were changes pertaining to new data, new methods, or new analyses, but the research question, objectives and inclusion criteria remained similar . In the case of new authors or a different research team updating an existing review, they had to clearly state that their review was an update and acknowledge the work of the authors on the previous edition .

The eligibility criteria based on population, intervention, comparator, outcome and study design are outlined below.

Population

Intervention

Comparator

Outcomes

Study design

Systematic reviews of all study designs investigating falls prevention interventions were considered for inclusion.

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Fatal Falls In Older Adults Are On The Rise

The title of this article is a little overly dramatic, although the CDC did report just that, and falls are the leading cause of injury in Americans over age 65. This article provides the stats as well as listing factors that increase fall risks for seniors, and strategies you can employ to prevent falling,

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Dealing With Overlap Of Primary Studies

Overlap of primary studies within included systematic reviews is a challenge exclusive to umbrella reviews. Currently, there is a lack of guidance on how best to manage this occurrence . To maximise comprehensiveness of this umbrella review, we employed a full inclusion scenario where all Cochrane reviews and non-Cochrane reviews were included . A list of the primary studies included in each systematic review was assembled and a matrix of evidence table was created to determine the amount of overlap between systematic reviews. To avoid double-counting outcome data the following were decided:

• Any systematic review that contained a relevant primary study that was not in any other systematic review was included so that data were not lost.

• Any systematic review that did not contain any unique primary study was excluded to minimise duplication of data.

• In the presence of complete overlap between reviews, the highest quality review, as determined by the A MeaSurement Tool to Assess Systematic Reviews 2 was included in data synthesis and analysis.

• In cases where there was a complete overlap between reviews and they received the same AMSTAR 2 rating, then the most recently published review was included.

• In the presence of partial overlap, all reviews were included but the degree of overlap was noted and its implications on the findings of this umbrella review were discussed.

Maximize Your Mobility With Fall Prevention

In this 20-minute lecture physical therapist, Heather Knight, explains different factors that play into our individual risks for falls, like tripping hazards, changes in walking surfaces and poor lighting, as well as what you can do to make your home safer to reduce your risk of falling and to strengthen movement.

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Data Synthesis And Analysis

Given the heterogeneity in populations, outcomes and analyses, the findings of included reviews were primarily summarised using a narrative synthesis with the quantitative tabulation of results as appropriate. The primary analyses for this umbrella review were centred on type of neurological condition and type of intervention. Following this, cross-comparison of similarities and differences in the effect of different interventions between the three conditions were reported and discussed. The outcomes of each included systematic review were considered and discussed in the context of their methodological quality, as determined by the AMSTAR 2 and the GRADE algorithm.

What Tests Will Be Done To Diagnose This Condition

When healthcare providers suspect Parkinsons disease or need to rule out other conditions, various imaging and diagnostic tests are possible. These include:

• Blood tests .
• Positron emission tomography scan.

New lab tests are possible

Researchers have found possible ways to test for possible indicators or Parkinsons disease. Both of these new tests involve the alpha-synuclein protein but test for it in new, unusual ways. While these tests cant tell you what conditions you have because of misfolded alpha-synuclein proteins, that information can still help your provider make a diagnosis.

The two tests use the following methods.

• Spinal tap. One of these tests looks for misfolded alpha-synuclein proteins in cerebrospinal fluid, which is the fluid that surrounds your brain and spinal cord. This test involves a spinal tap , where a healthcare provider inserts a needle into your spinal canal to collect some cerebrospinal fluid for testing.
• Skin biopsy. Another possible test involves a biopsy of surface nerve tissue. A biopsy includes collecting a small sample of your skin, including the nerves in the skin. The samples come from a spot on your back and two spots on your leg. Analyzing the samples can help determine if your alpha-synuclein has a certain kind of malfunction that could increase the risk of developing Parkinsons disease.

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So What Relationship Do The Health Effects Of Parkinsons Have With Death

The adverse health effects of Parkinsons are serious, and you should work with your doctor to explore the many ways to manage your Parkinsons symptoms. However, Parkinsonian symptoms do not directly cause death, but they do increase your risk for other factors that can lead to death. For instance, one of the symptoms of Parkinsons is postural instability which leads to an increased risk of falls. Postural instability by itself will not cause death but falls can lead to serious injuries that can result in death. So, Parkinsons symptoms can increase the risk for death but will not cause death in and of itself.

This is an important distinction to make because instead of seeing Parkinsons as a death sentence we should look at it as a manageable risk factor the same way we look at dieting. A poor diet will not kill you, but it will increase your risk for developing diseases that can. We should think of Parkinsons in the same way, that if we manage our symptoms of Parkinsons through exercise, medication, etc. we decrease the likelihood of risk factors that lead to death.

Death In Parkinsons Disease

This article was written at the request of a Parkinsons patient who wanted to know how patients die from PD.

Most patients die with Parkinsons Disease and not from it. The illnesses that kill most people are the same as those that kill people with PD. These are heart conditions, stroke and cancer. As we age we become increasingly aware that more than one bad thing can happen to our bodies.

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Impact Of Falls And Parkinson’s Disease

This 8-minute video alternates between an interview with a man sharing his experience of falling due to Parkinson’s disease, with a doctor, physical therapist and occupational therapist explaining why people with PD fall, the benefit of physical therapy and exercise before a person has ever fallen to prevent falls and what an occupational therapist can do to prevent falling at home and in the broader environment.

How Is It Treated And Is There A Cure

For now, Parkinsons disease is not curable, but there are multiple ways to manage its symptoms. The treatments can also vary from person to person, depending on their specific symptoms and how well certain treatments work. Medications are the primary way to treat this condition.

A secondary treatment option is a surgery to implant a device that will deliver a mild electrical current to part of your brain . There are also some experimental options, such as stem cell-based treatments, but their availability often varies, and many aren’t an option for people with Parkinsons disease.

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Comparison Between Fallers And Non

Table 1 shows the differences in demographic and historical data between fallers and non-fallers. It should be noted that one subject reported 500 falls in the year before assessment otherwise, the range would have been 0100. Fallers had longer disease duration than non-fallers and were more likely to describe previous falls.

Table 1

Historical data and falls among 101 patients with Parkinson’s disease

Table 2 shows the differences between fallers and non-fallers in disease severity and other rating scales. There is a strong association between disease severity and the risk of falling. This is particularly true with an MHY rating > 2.5 and with higher UPDRS subtotal II , subtotal III , or total UPDRS score. Cognitive impairment was also associated with increased GDS or PDQ = 8 and a risk of falls. One subject had an MMSE of 0 otherwise, the range would have been 1530.

Table 2

Disease severity and rating scales

Although there was no association between a worse shoulder pull and falling, there was an association between an increased number of falls and a positive shoulder pull, using the positive pull as the independent variable in a Mann-Whitney U test .

Table 3

Physiotherapy assessment and falls

Different sample sizes are quoted for the cardiovascular and autonomic assessments owing to different entry criteria and withdrawals. In these cases fractions and percentages are quoted . None of the cardiovascular or autonomic data were associated with falling.

It’s Not All Dopamine: Possible Mechanisms And Interventions For Falls In Pd

In this 1-hour talk Rober Albin, movement disorder specialist and researcher, describes the impact of dopamine and acetylcholine in Parkinson’s through some animal and human trials. Research has found a nicotine-like drug is very safe, well tolerated and seems to improve attention in those with PD.

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Work With A Physical Or Occupational Therapist

Physical therapists can also help you develop an exercise routine that meets your needs and helps you maintain strength and mobility as long as possible. Occupational therapists help you find ways to continue your day-to-day activities by suggesting modifications to your environment and help you develop coping and management skills. Your doctor offer advice about which type of therapy is best for you.

Increased Feelings Of Anxiety Or Depression

Anxiety and depression have been linked to Parkinsons. In addition to movement problems, the disease can also have an impact on your mental health. Its possible that changes in your emotional well-being can be a sign of changing physical health as well.

If you are more anxious than usual, have lost interest in things, or feel a sense of hopelessness, talk to your doctor.

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The Finding Could Lead To Tailored Treatment To Improve Quality Of Life

Date:

University of Calgary

Summary:

Parkinson’s disease causes one of the highest risks of falling among all neurological conditions. Due to this, many patients develop a fear of falling, even if they’ve never fallen. Researchers have discovered a way to diagnose subtypes of fear of falling in hopes of improving treatment and quality of life for patients.

Parkinson’s disease, a progressive nervous system disorder that affects movement, causes one of the highest risks of falling among all neurological conditions. Due to this, many patients develop a fear of falling , even if they have never fallen. For some the fear can be excessive. Patients become prisoners in their own homes, scared to venture out despite the fact that they are physically able to do so. Others can develop a “fearlessness” putting themselves at high risk of falling.

Vivien Poon was diagnosed with Parkinson’s 10 years ago. She walks with the use of a cane and says her fear of falling is something she has to deal with on a daily basis. “I’m pretty lucky. Although I’ve fallen many times, I’ve only broken a finger. For a lot of patients, falls lead to serious injury,” says Poon.

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What Does Kill People With Parkinsons

While no one dies directly from Parkinsons, you may be asking yourself what does typically cause death in Parkinsons patients. The two of the biggest causes of death for people with Parkinsons are Falls and Pneumonia:

Falls Parkinsons patients are typically at an increased risk of falls due to postural instability and other symptoms of Parkinsons. This poses a great risk to those with PD because falls are the leading cause of injury-related deaths among those 65 years or older according to the CDC. It is important to take precautions to limit the risk of falling in your home. This can be done by wearing special grip socks to prevent slipping or installing handrails in high-risk areas like the shower or staircase. In addition, you should talk with your doctor about getting a physical therapy evaluation periodically to strengthen your balance reflexes and help you develop other strategies to keep you safe in the home.

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Is Parkinsons Disease Fatal

Parkinsons disease itself doesnt cause death. However, symptoms related to Parkinsons can be fatal. For example, injuries that occur because of a fall or problems associated with dementia can be fatal.

Some people with Parkinsons experience difficulty swallowing. This can lead to aspiration pneumonia. This condition is caused when foods, or other foreign objects, are inhaled into the lungs.