Due to the nature of Parkinson’s disease, falls are a fairly common occurrence mainly due to instability with the posture and impaired gait. Falls and freezing of gait are the two most common interconnected phenomenon associated with patients of Parkinson’s disease. It has a host of complications as would frequent falls in any person, irrespective of Parkinson’s disease.
These symptoms often incapacitate the patients and the associated far-reaching physical and psychological factors have a great impact on the patients. The risk of injury is evident in these patients as the disease progresses. This diminishes the quality of life, and the survival rate of patients. The patient is unable to walk independently and the additional treatment cost of injuries leads to a substantial increase in the financial burden on the family.
However, bearing in mind that most Parkinson’s disease patients are older, the impact of these frequent falls can have severe consequences. Understanding the dangers associated with frequent falls and minimizing it is of the utmost importance.
Why do Parkinson’s disease patients fall so often?
Parkinson’s disease leads to rigidity, impaired balance and slowness of movement or freezing of gait. This means that even when a Parkinson’s patient foresees a potential hazard, he/she cannot accommodate with rapid counter movements. The fear of falling and the resultant reduced mobility are an important variable in the recurrent fallers having Parkinson’s disease.
The increased frequency of falls in the Parkinson’s patients is often linked with, and analyzed as a continuum in relation to increasing age, disease severity, postural instability, cognitive impairment, leg-muscle weakness, freezing of gait, orthostatic hypertension, visual impairment and an increase in the dose of levodopa.
As the condition progresses, the frequency and often severity of falls increases proportionally. With time, a person loses his/her confidence and actually becomes more prone to falling by ‘second guessing’ their movements and counter movements when standing and walking.
The postural instability also means that a person cannot stay firmly planted when stationary or even when walking slowly and is therefore prone to falls and associated injuries.
Orthostatic hypotension (postural low blood pressure) is also frequently seen in Parkinson’s disease and may also be cause of frequent falls although this association has not been conclusively proven. Visual problems also need to be taken into account as a possible cause of falls in Parkinson’s disease.
Effects of Frequent Falls
Falls are the second most common cause for hospitalization in Parkinson’s patients. They are the result of postural instability and the frequent falls causes significant morbidity or even mortality in severe cases of Parkinson’s disease. Falls are the main reason of hospitalization and wheelchair confinement in these patients. The need of healthcare services after an injury or a fall is higher among the older patients suffering from PD.
Frequent falls may lead to repeated fractures. The most common fractures include either arm, rib,clavicle, femoral and hip fractures. Hip fracture is the commonest type of fracture which occurs following fall in a Parkinson’s disease patient. Weakened bones owing to osteoporosis in the older age increases the propensity towards fractures. The patient might have a tottering gait and may subsequently succumb to death due to the consequences of grave fractures.
Female patients, Low bone mass index, older age, and less bone mineral density are the major factors responsible to cause fractures. The slower and less successful rehabilitation process after these fractures aid to the morbidity of this disease. Fractures and related injuries lead to longer periods of immobilization which in itself has its own consequences such as depression, constipation, weakness, loss of confidence and insomnia. More severe falls can even lead to traumatic brain injury causing concussions, seizures and depending on the complications even contribute to death.
Soft tissue contusion and bruising is the most common injury which occurs in both indoor and outdoor falls. The patients usually have a high level of consciousness and anxiety towards falling which results to the diminished confidence, independence and quality of life
Tips for Preventing Frequent Falls
There is no single solution to preventing falls in Parkinson’s disease. Gait and step training might reduce the frequency of associated falls in Parkinson’s disease. In fact, it is not a matter of preventing falls entirely as this is common in life and particularly with old age, apart from the Parkinson’s disease component. Therefore the focus should be on preventing frequent falls and minimizing the extent of the injury. This involves a number of factors that both Parkinson’s disease patients and caregivers need to bear in mind :
- Some studies have shown that exercise and physical therapy may reduce the frequency of falls as it improves postural stability and balance.
- Consult a physical therapist who can assess the walking and balance. Gait Training is given to the patients by making them walk on the treadmill at a speed higher than that on the ground. The patients are made to walk in 4 different directions and are supported in a harness for safety.
- For step-training the treadmill is switched on and, off abruptly with the patient standing in safety harness facing either forwards backwards or sideways. Gait and step training leads to the reduction in the number of falls and an overall improvement in the gait and dynamic balance of PD patient.
- Cognitive behavioral therapy used in combination with the physical training has been shown to reduce the fear of falling and the associated reduced mobility in the general older population suffering from Parkinson’s disease.
- Consider safety tips advised for Parkinson’s patients and appropriate changes in the home environment that will limit falls and the extent of injuries.
- Install grab bars and non skid bath mats in the bathroom to avoid falls.
- Maintain proper lighting in the halls, stairways and entrances. The light switch must be installed on the top and bottom of stairs.
- Install non skid rubber mats near the sink and stove in your kitchen.
- Take medication as prescribed to reduce the severity of motor symptoms.
- Always seek medical attention even after a minor fall to identify the full extent of injuries and have it treated immediately to limit the complications.
- Wear appropriate footwear that may be helpful in moving without restriction and enhancing postural stability.
- Heels should be avoided as far as possible.
- Never have both hands occupied when walking to ensure that one hand can grab onto surrounding objects and break the force of the fall.
- Do not get distracted while walking as even talking can be a contributing factor to falls since multitasking may be difficult for the Parkinson’s brain.