Falls and dizziness
This information looks at some of the reasons why people with Parkinson’s might fall. It gives helpful tips on what you can do to prevent falls and explains which professionals can offer you support.
Loss of balance and falling affects many people with Parkinson’s and the problem tends to increase over time. But everyone’s experience of Parkinson’s is different, so you may not have these difficulties.
What might cause me to fall?
Balance problems and Parkinson’s
Many people with Parkinson’s have problems with their balance, which can lead to falling.
Movement (motor) symptoms of Parkinson’s
If you have Parkinson’s, you might fall because you:
- take steps that are too slow or small (bradykinesia), or that vary in size
- walk or turn too fast
- do not swing your arms when you walk.
Involuntary movements (dyskinesia), which can be a side effect of some Parkinson’s medication, can also cause falls. And anxiety can make these movements more severe, which could make a fall more likely.
Freezing
Some people with Parkinson’s fall because they have problems starting to move, or suddenly "freeze" while moving. Freezing can last for a few seconds or minutes.
Although freezing can happen at any time, you may experience it when you are:
- walking towards or through doorways
- moving from one style of flooring to another, such as from carpet to tile
- distracted, anxious or hurrying
- in a busy or crowded place.
If you freeze, you may feel like your feet are stuck to the floor, which can make you unsteady and increase your risk of falling.
If your medication is "wearing off" before your next dose is due, freezing may get worse. Speak to your specialist or Parkinson's nurse as they may be able to adjust your medication.
Posture and stiff (rigid) muscles
Parkinson’s can also lead to changes in your posture. You might become more stooped (bent forward). This can make it more difficult to steady yourself if you trip.
Your muscles may also become more stiff (rigid). This can increase your risk of falling. It can also mean you are less able to break or soften your fall, so are more likely to injure yourself.
But getting help early, such as from a physiotherapist or occupational therapist, can make you safer and more confident.
General muscle weakness (sarcopenia)
Sarcopenia is when your muscles become weaker and lose some mass. This may happen as you get older, or if you aren’t able to get much exercise. As Parkinson's may make it more difficult to stay active, your muscles may lose some strength. This can increase your risk of falling.
But adapting your exercise as your symptoms change can help you stay active and help keep your muscles and joints strong and flexible.
Eating enough protein to build and maintain muscle is important too.
Read our magazine article on protein.
Read more about physical activity.
Problems with blood pressure
Older people are more likely to have blood pressure that is too high (hypertension) or too low (hypotension). And some Parkinson’s medication can cause problems with blood pressure, which can lead to dizziness and falls.
If you have felt dizzy, or fallen because of dizziness, your GP practice can check whether your blood pressure is too low. They should take readings when you are lying down, sitting and standing. You may also be able to check your blood pressure at home, using your own blood pressure monitor, or for free at a pharmacy. Find a pharmacy that offers free blood pressure checks.
Drugs used to treat other medical conditions can make dizziness worse. You might notice this even more if you are losing weight or not eating and drinking enough.
Postural hypotension is a sudden drop in blood pressure when changing position, for example when getting up out of a chair. It can make you feel very lightheaded, which will affect your balance. Postural hypotension can be a symptom of Parkinson’s, or be caused by the drugs used to treat Parkinson’s.
You temporarily raise low blood pressure by drinking more fluids. Drinking a glass of ice-cold water in the space of 5 minutes can help.
Full length support stockings can also help with symptoms of low blood pressure. You can get these on prescription or over the counter. Some people find that wearing an abdominal binder can help too.
Read more about low blood pressure.
Managing dizziness
You can avoid some dizzy spells by taking your time before each movement, such as turning, lifting anything or bending down. For example, before you get out of bed, sit with your feet touching the floor for a few minutes. Then stand up slowly, but do not walk until you feel steady.
Your doctor or Parkinson’s nurse can suggest ways to reduce dizziness and keep you steady.
Eye problems
Parkinson’s can cause difficulty moving your eyes. This can mean you don’t always see obstacles around you in time. And some Parkinson’s drugs (including anticholinergics) can cause blurred vision. If you can’t see hazards clearly, you may be more likely to trip and fall.
You may also have difficulty judging the space around you or the distance between objects. This could cause problems finding your way past objects or through narrow spaces.
Regular eye tests can help you get any support you might need for your eyes. If you wear glasses or contact lenses, your optician will check that you have the right prescription.
Foot problems
Parkinson’s, and some Parkinson’s medication, can cause stiffness (rigidity) or swelling in your feet. This can make walking more difficult and might mean you need more help from healthcare professionals to look after your feet.
Some Parkinson’s medication can cause your toes to curl under the foot, or make your foot “drop” or drag. Some people also experience lifting of their toes or pulling of their feet in different directions (dystonia). This can make it difficult to walk properly or cause you to trip.
If you notice this, speak to your specialist or Parkinson’s nurse. They may suggest changing your medication or refer you to a specialist physiotherapist.
Flat feet and hard skin on your feet
Our feet can press flatter on the ground as we get older, which can change the way we walk. This is called flat feet, or “fallen arches” and often doesn’t need any treatment.
Comfortable fitting shoes which support your feet can help you walk with flat feet. And if hard skin or corns on your feet make walking difficult, a podiatrist can help.
A podiatrist, sometimes called a chiropodist, is a healthcare professional who treats people with foot problems. Your GP may be able to refer you to a podiatrist, or, if that’s not possible in your area, you could pay to see one privately.
Reducing the risk of falling
There are lots of ways to reduce your risk of falling. Below are ideas that physiotherapists and occupational therapists have suggested to help with balance problems.
Your GP, specialist or Parkinson’s nurse can also give you advice on how to avoid future accidents or refer you to a physiotherapist or occupational therapist.
Plan ahead
It might help to break movements down into stages, such as:
- think
- scan
- plan
- move.
Take the time to plan a route and decide how to deal with any hazards before you start moving.
Get into a rhythm when you walk
You might find it helpful to:
- count each step
- march on the spot
- hum or sing to yourself
- repeat words or phrases like "walk tall" or "stride out" to help you stay focused.
Move to the beat
Walking to the tick of a metronome can help you maintain a rhythm, or help you restart walking if you freeze. A metronome produces a regular beat to help musicians keep to a rhythm. They are available from musical instrument shops or online, or you can download a metronome app to a smartphone or tablet.
Focus on taking longer strides and swinging your arms
Taking bigger steps will help to increase your arm swing. Gently swinging both arms will help you keep your balance when you walk.
Looking into the distance rather than immediately in front of you may also help you to correct your posture and reduce your risk of freezing.
Shift your weight
Move your weight from one foot to the other, or try to step backwards before moving forwards. If you freeze, you may be able to re-start moving by rocking gently from side to side.
Ask someone to help
If you freeze or lose your balance, having someone who can hold your arm and support your balance can help you concentrate on moving again.
Avoid distractions
Try to concentrate and keep distractions to a minimum. Avoid walking and talking at the same time.
If you want to have a conversation, pause and touch something solid, such as a lamp post, when you want to talk.
If the surroundings are busy, scan the area and plan your route in short stages. That way you're not having to concentrate on too much in one go.
Slow down turns
If you need to change direction, try not to turn too quickly or turn on the spot. It's better to slow down and take a few extra steps to walk around in a half circle.
If you do need to turn on the spot, try to imagine your feet are following the numbers on the face of a clock.
Take your time, especially if you are carrying something.
Parkinson's medication and "wearing off"
When your medication starts to "wear off" (work less well), you may have trouble moving. "Off" periods can start suddenly and unpredictably, which could cause falls.
If you have sudden "off" periods, speak to your specialist or Parkinson’s nurse. They may adjust your medication, which may help reduce your risk of falls.
Speak to your specialist or Parkinson’s nurse if your:
- drugs don't seem to work as well as they used to
- medication’s side effects are causing you to fall.
If you have dizzy spells which may make you more likely to fall, make sure you’re taking your medication as prescribed. Set an alarm or use an app to remind you about your medication, food and drinks, and follow your specialists’ advice about when and how to take them.
Being "on" or "off" is different from freezing. During "off" periods, some people with Parkinson’s are not able to move at all. This is different from freezing, which only affects certain movements or parts of the body.
Freezing and "off" periods should be treated as separate problems by your specialist or Parkinson’s nurse. But either could cause a fall.
Your specialist and Parkinson’s nurse can help you work out if you’re freezing, having "off" periods, or both, and recommend the right treatment for you.
Read more about wearing off and involuntary movements.
Hazards in and around your home
Here are some tips to reduce hazards in your home:
- Clear away as much clutter as you can and arrange your furniture so that moving around is easy. In the garden, keep paths clear. Some people find that level, flat paving slabs are easier to walk on than gravel or woodchips.
- Hand or grab rails can be useful in tight spaces, such as toilets or bathrooms. They can be useful on both sides of the stairs too. Non-slip mats can make slippery floors in areas like bathrooms more secure. An occupational therapist may be able to provide these for free.
- Floor coverings can be a hazard. For example, carpet patterns can be confusing to walk on. Speak to an occupational therapist or physiotherapist about applying strips of tape or plastic footsteps on the carpet. These can guide you in places you might be more likely to fall, such as a tricky turn on stairs, or in doorways.
- Keep your house well lit, especially around stairs. Keep a torch by your bed. Many mobile phones also have a torch function.
- Apply strips of coloured tape to the edge of steps to make them more visible and prompt you to lift your feet.
- Keep the things you use most often close to hand, so you don't need to bend down or stretch too far to get them.
- Always use a step or stepladder, not a chair or any other piece of furniture, to reach up high.
- Try not to rush, even if the phone’s ringing or there’s someone at the door.
- If you have pets that tend to get under your feet, put a bell on their collar.
Physical activity
The more fit and active you are, the better your body is able to cope with everyday life, making you less likely to fall.
In some areas of the UK, you can be referred to the Exercise Referral Scheme. A fitness instructor can tailor a programme to your individual needs. You may also be able to access Staying Safe or Falls Prevention programmes. Your GP, nurse or another health professional may be able to tell you about schemes in your area and refer you.
You’re most likely to continue with an activity you enjoy. This may be different as your symptoms change.
Find the best ways to get active and stay active, even at home.
Equipment and walking aids
The correct walking aid can increase your confidence and help you to lift your feet better. This might be a walking stick or a rollator (a frame with wheels).
Before you start using a walking aid, it's very important to get advice from a physiotherapist or occupational therapist. Some walking aids aren't recommended for people with Parkinson’s as they can affect your walking pattern and make you more likely to fall.
Footwear
Shoes with low heels or flat soles may be easier to walk in. Avoid unsupportive shoes, such as floppy slippers.
An occupational therapist or physiotherapist can give you advice about shoes and ways to make walking easier and safer.
Preparing in case of an emergency
- Make sure you have contact numbers nearby. Keep a mobile phone with you, or use a cordless landline telephone that you can carry with you, in case you need to call for help. Or try a voice-activated home assistant device, such as an Alexa, which you can activate with your voice.
- A community alarm system can be helpful. If you fall, you can press the button on a small wearable device to alert an emergency response centre. They will send a trusted person such as a family member, or the emergency services to help you. Speak to your local social services, social work department or health and social care trust for details of local schemes. There is usually a cost for this service. You may be able to download an app to your smartphone that works in a similar way.
- Consider installing a keybox or safe outside your house so that trusted people or health professionals can get inside even if you cannot move.
- NHS Inform has an article and short films with step-by-step instructions for what to do if you fall. Practice getting up safely, if you can.
- Keep an up to date list of your conditions, medications, routines and support contacts by your front door.
- Pack a small bag with the essential items you would need if you have to leave home unexpectedly after a fall. This might include the lists above, medications, walking aid, devices, chargers and information about your condition.
Our expert helpline can give you advice on how you could make your home safer, or help you find further support. Call free on 0808 800 0303.
If you do fall
After a fall
Once any injuries have been treated, you may be referred to a falls clinic, frailty unit or falls prevention services. A team of health and care professionals will look at your health, movement and surroundings for things that make a fall more likely, and give advice on how to reduce the risk.
In some areas, you may be admitted to a virtual (online) ward for a short time. This means you can be cared for at home, rather than going into hospital. You’ll be looked after by a team of health professionals, who can run tests, such as for blood pressure, and monitor your recovery. They can prescribe treatments, make changes to your medication or refer you for different therapies.
Falls and looking after your bones
Falls can be dangerous for anyone, but people with Parkinson's are more likely to have bone problems, which can make the impact of a fall worse. This includes a condition called osteoporosis, which can weaken bones and make them more likely to break (fracture) if you fall.
There are lots of ways to look after your bones and reduce the risk of breaking a bone if you do fall.
- Bones get weaker as we get older, so weight-bearing and strength (or resistance) exercise is really important to keep bones and muscles strong.
- Lots of people are low in vitamin D, which helps the body to absorb calcium from food and keep bones strong. We can get some vitamin D from food, but, from late March to the end of September in the UK, most is produced when we are outdoors in the sunshine. The UK government recommends everyone consider taking a vitamin D supplement during the winter, when we can’t make enough vitamin D from sunlight.
- If your GP thinks your bones are weak, they can refer you for a DXA (DEXA) scan to measure your bone density. If needed, they can prescribe medication to help keep your bones strong.
Read our magazine article about bone health.
Fall detectors
Fall detectors (or fall alarms) can be helpful, and an occupational therapist can often provide one for free. They can be worn around the wrist like a watch, or around the neck like a pendant. Request an occupational therapist assessment through the GP, or your local adult social care department.
The Parkinson’s UK Tech Guide
There are many devices and apps available that claim to be useful for people with Parkinson’s.
The Tech Guide is a reliable source of information about devices and apps for people with Parkinson’s. It's available online or in print.
Products in the guide are tested by people with Parkinson’s, who give their honest reviews. These reviews may help you to decide whether an app or device could help you, before spending money or time on it.
Advice to share with people close to you
If someone falls
- Do not try to lift them unless you know how to do this safely. Lifting someone incorrectly could injure you, or the person who has fallen. Your local authority may provide free e-learning or training courses for carers to learn how to move people more safely (manual handling skills).
- Try to understand what has caused the person to fall.
If someone cannot get up from a fall, call 999
- If someone has fallen and can't get up, call 999 for help.
- Follow the operator’s instructions.
- Let them know what has caused the fall if you can, and whether the person has visible injuries. Your local 999 operator may be able to contact a service to support people to get up from a fall.
While you wait for help from a paramedic
- If you can’t lift someone from the floor:
- keep them as comfortable as possible
- Make sure they are warm, offer them a blanket if needed
- stay calm and reassuring.
Supporting someone with Parkinson’s after a fall
- After a fall, someone with Parkinson’s should always see their GP. Even if they do not seem hurt, a GP can also look into the reasons why they fell, and how to prevent a future fall.
- If you’re close to the person with Parkinson’s:
- encourage them to make a GP appointment, or ask them how it went
- ask them if there’s anything you can do to help them prevent a future fall, such as:
- removing trip hazards from their home
- getting a falls detector.
Professionals who can help
If you’re worried about falls, have fallen or have been feeling dizzy, make an appointment with your GP, specialist or Parkinson’s nurse. You can discuss together what can be done to improve your safety and balance and arrange for a referral to a physiotherapist or occupational therapist if needed.
Physiotherapists
A physiotherapist can help you improve your:
- balance
- strength
- mobility.
These can all reduce your risk of falling.
They can teach you to get down on to the floor and back up safely. Often, a physiotherapist works with an occupational therapist to help you remove tripping hazards from your home.
They may be able to provide you with any equipment or walking aids, and can help you to keep active safely.
Getting a physiotherapy referral
Ask your GP, specialist or Parkinson’s nurse about a referral for physiotherapy as soon as possible after your Parkinson’s diagnosis, or if you need support with your physical symptoms.
In some areas, you can refer yourself at the local hospital or a community health centre. You can also pay to see a private physiotherapist. The Chartered Society of Physiotherapy can help you find one.
Find a physiotherapist through The Chartered Society of Physiotherapy.
Local sessions
Some Parkinson’s UK local groups have sessions led by a physiotherapist.
- Call our helpline on 0808 800 0303
- or find your local group using our online search.
Read more about physiotherapy.
Occupational therapists
An occupational therapist’s job is to help you stay independent in your daily life. As part of this, they can suggest ways to reduce your risk of falls.
They might:
- ask you to keep a diary about when, where and how you fall
- recommend equipment to help reduce the risk of falling, or help you get up if you do fall
- help you manage fatigue and energy levels.
Getting occupational therapy support
You can contact an occupational therapist through your:
- GP
- social services or social work department
- health and social care trust.
You can also pay for private occupational therapy. To find a qualified private occupational therapist in your area, contact the Royal College of Occupational Therapists.
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