A prospective multidisciplinary study of falls in Parkinson's disease
Introduction. Despite being thought of as common and having serious consequences, falls have not been extensively studied in Parkinson’s disease (PD). Prior to this study commencing there were no published large-scale prospective studies looking at the risk factors for falls in PD. This study aimed to accurately establish the incidence of falls in PD and investigate predictive risk factors for fallers from baseline data in all patients known to a district general hospital PD service. In addition cardiovascular investigation, autonomic function and osteoporosis in PD were assessed. Methods. Baseline data was gathered on a cohort of 109 patients with idiopathic PD and the number of falls prospectively ascertained over the following year. The multidisciplinary baseline assessment included historical data, disease specific rating scales, physiotherapy assessment, tests of visual, cardiovascular and autonomic function and bone densitometry. Results. Falls occurred in 68.3% of the subjects. Previous falls, disease duration and loss of armswing were independent predictors of falls and recurrent falls. There were also statistically significant associations between disease severity, balance impairment, depression cognitive impairment and falling. Males were more likely to suffer from recurrent falls. Cardiovascular disorders, autonomic dysfunction and osteoporosis were also highly prevalent but not associated with falls. Conclusions. Falls are a common problem in PD. Some of the risk factors are potentially modifiable. Although there are intrinsic factors inherent to PD that can cause falls, patients with PD that fall should be thoroughly assessed to look more closely at the reason for falling in those individuals. Potential primary prevention of falls should be considered in all patients with PD. In the future, multi-centre intervention studies will be necessary to further investigate potential methods of decreasing falls and their effects in PD.