Falls and dizziness
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.
Why do people with Parkinson's fall?
Whether you have Parkinson’s or not, you may be more likely to fall if you:
- are older and frailer with a limited range of movement
- have had previous falls
- experience depression
- have dementia
- are taking medication that can cause drowsiness
Sometimes, people may experience falls for other reasons, including old age and other types of parkinsonism. Over time, people with Parkinson’s may become more likely to fall.
If you have Parkinson’s, you may fall because of poor balance, you take steps that are too small or that vary in size, or because your arms do not swing when you walk. Involuntary movements (dyskinesia), which are a side effect of some Parkinson’s medication, can also be a reason.
What causes falls?
Some people with Parkinson’s fall because they have problems starting to move or they ‘freeze’ while they are moving. Freezing is when you stop suddenly, and it can last for a few seconds or minutes. If this happens, you may feel as though your feet are stuck to the floor or you’re unable to move easily, which can make you feel unsteady. This can increase your risk of falling over.
If you have difficulty with your medication wearing off before your next dose is due, you may find freezing becomes worse. Speak to your Parkinson’s specialist or nurse as they may be able to adjust your medication.
As Parkinson’s progresses, your posture can change. You may become more stooped and your muscles may become more rigid. Having muscles that are less flexible can increase your risk of falling, as it’s more difficult for your body to move and for you to protect yourself if you lose your balance.
General muscle weakness
People with Parkinson’s can be much less active than they used to be, which can cause muscles to become weaker. This weakness can be a major cause of falls. Staying active can help muscles and joints from getting stiff and rigid.
Problems with blood pressure
Some Parkinson’s medication can cause side effects, which can include problems with blood pressure. This can lead to dizziness and falls. Problems with blood pressure can also affect people generally as they get older.
If you’ve felt dizzy, or fallen because of dizziness, ask your GP or practice nurse to check your blood pressure both when you’re sitting and standing, to see if it’s too low.
Postural hypotension is a sudden drop in blood pressure when changing position, for example getting up out of a chair. It can make you feel very light-headed, which will affect your balance. You may experience postural hypotension as a symptom of Parkinson’s. But it can also be caused by the drugs used to treat Parkinson’s.
Drugs used to treat other medical conditions, such as high blood pressure, can potentially make dizziness worse, especially if you are losing weight or not eating and drinking as well as you used to. Make sure you let your GP, specialist or Parkinson’s nurse know if you have dizzy spells or falls.
You can avoid some dizzy spells by just taking your time. For example, before you get out of bed, sit with your feet touching the floor for a few minutes before you stand up.
When sitting on a chair or bed you could also try marching your feet on the spot for a few minutes to get your blood flowing. Then stand up slowly, but try not to walk away immediately – stand for a while until you feel steady.
Some people with Parkinson’s experience problems with their eyes.
Difficulty moving your eyes and side effects of some Parkinson’s drugs (including anticholinergics) can cause blurred vision. If you are unable to see hazards clearly, this may make you more likely to fall.
Because of Parkinson’s, you may also have difficulty judging the space around you. You may not be able to accurately assess the distance between objects and may experience problems finding your way when walking past objects or through a narrow space.
Bifocal glasses may also affect how well you judge distance.
Reducing the risk of falling
It is important to get help and advice about how to avoid falls. Whether or not you have fallen over before, anxiety or fear of falling can increase the likelihood of it happening. Your GP, specialist or Parkinson’s nurse can offer advice on how to avoid future accidents, or refer you to a physiotherapist or occupational therapist.
Seven steps to better walking
Here are some of the things physiotherapists and occupational therapists have suggested you can do to help overcome balance problems:
Get into a rhythm when you walk
Try counting each step, marching on the spot, stepping over patterns on the floor, humming or singing to yourself. You might use a mantra such as ‘walk tall’ or ‘stride out’ to help you stay focused when walking.
Move to the beat
As an alternative to counting or chanting, a physiotherapist may suggest walking to the tick of a metronome to help you maintain a rhythm. A metronome is a device that produces a regular tick or beat that musicians use to keep to a rhythm. They are available from musical instrument suppliers.
If you freeze regularly, a physiotherapist may recommend that you use one to help you restart walking.
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.
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 a friend to help
If you’re out with a friend and you freeze, they can help you by holding your arm and supporting your balance while you concentrate on moving again. Ask them to put their foot at a right angle in front of yours for you to step over it. Just make sure you raise your foot above theirs and remember not to step backwards, to avoid disturbing your balance.
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 crossing a busy area plan your route in short stages so that you are 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 pivot on the spot. It is better to slow down and take a few extra steps to walk around in a half circle. Try to imagine your feet are following the numbers on the face of a clock. Take your time.
Falls, dizziness and Parkinson’s medication
You can avoid dizzy spells, which may make you more likely to fall, by making sure you’re taking your medication as prescribed.
Falling can be more likely depending on how well your symptoms respond to medication and whether this regularly changes, or fluctuates. For example, you may freeze when you are ‘off’ (when your medication is not working so well) and this can cause falls. So any changes your specialist or Parkinson’s nurse makes to your medication to reduce freezing may also help to reduce falls.
If your drugs do not seem to work as well as they used to, or you think you are falling due to side effects of your medication, speak to your specialist or Parkinson’s nurse about making changes to the drugs you are taking.
Hazards in and around your home
There are many things in the home that could be hazardous and make you more likely to fall, including slippery floors, loose carpets and general clutter. Here are some tips on how to reduce hazards in the home:
- Try to clear away as much clutter as you can and arrange your furniture so that moving around is as easy as possible. If the furniture is heavy, make sure you ask someone to help you move it.
- Hand or grab rails may be useful in tight spaces, such as in toilets, bathrooms or by the stairs. Putting non-slip mats in the bathroom will also help.
- Make sure your house is well lit.
- Apply strips of coloured tape to the edge of steps to make them more visible and help prompt you to lift your feet.
- Keep commonly used items close to hand and make sure you have contact numbers nearby in case of an emergency. Keep a mobile phone with you, or change your landline telephone to a cordless model so that you can carry it with you.
- Try not to rush, even if the phone’s ringing or there’s someone at the door.
- If you’re prone to falls, you might find a community alarm system really helpful. This involves wearing a small device that has a button to alert an emergency response centre, who will send someone to help you. Age UK runs this type of service and your local social services, social work department or health and social care trust can give you details of other local schemes. There is usually a small cost for this service.
- Floor coverings can sometimes be a hazard. For example, carpet patterns can be visually confusing. 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 may be more likely to fall, such as a tricky turn on stairs, or in doorways.
Other ways to reduce the risk of falling
Though it might be tempting, try not to restrict all your activities to prevent falls, as this is likely to cause joint stiffness or muscle weakness. This can increase your chance of having a fall because your body won’t be used to moving and maintaining its balance.
It is important to try to stay as active as possible and exercise regularly to help you maintain your mobility and prevent falls.
If you want to take part in leisure activities outside the home, an occupational therapist can give you advice about local help and facilities available that might make this easier for you.
Remember that as long as you take care, there is no reason to let the risk of falls stop you doing what you want to do. Staying active and doing the things you enjoy may help you maintain your physical and emotional wellbeing.
The more fit and active you are, the better your body is able to respond to the demands placed on it, making you less likely to fall and injure yourself. In some areas of the UK, you can be referred for a fitness review through the Exercise Referral Scheme, and see a fitness instructor who can tailor a programme to your individual needs. Your GP may be able to tell you about schemes available in your area and refer you.
The scheme also gives you reduced fees at a gym. Several gyms are signed up to the Inclusive Fitness Initiative, which ensures that they provide an accessible environment for everyone, including providing adapted equipment for people with disabilities.
Equipment and walking aids
You might find that equipment can help you to walk, such as a walking stick or a rollator (a frame with wheels).
Before you start using a walking aid, however, it is very important to get advice from a physiotherapist. Some walking aids are not always recommended for people with Parkinson’s. They can have a bad effect on your walking pattern and could make you more likely to fall. However, the correct walking aid can increase your confidence and enable you to lift your feet better.
You might find some shoes better than others. Footwear with low heels or flat soles might be helpful. Try to avoid unsupportive shoes, such as floppy slippers. An occupational therapist or physiotherapist can give you advice about what shoes to wear and ways of making the places where you walk easier and safer to manage.
Professionals who can help with falls and dizziness
If you are experiencing falls, make an appointment with your GP, specialist or Parkinson’s nurse to talk about what can be done to improve your safety and balance.
The following professionals can also help:
A physiotherapist uses physical treatments, including exercise, to prevent or reduce stiffness in joints and to help build muscle strength and mobility. They can show you exercises to help maintain your posture and balance and can advise you on ways of preventing or reducing your risk of falling. They can also teach you ways to get up after having a fall, which will help you stay confident and independent. A physiotherapist can also advise or train family and carers on safe ways of helping you with any mobility problems.
Your GP, specialist or Parkinson’s nurse will usually be able to refer you to a local physiotherapist. Alternatively, the Chartered Society of Physiotherapy has a register of private physiotherapists who specialise in the treatment of neurological conditions, including Parkinson’s.
An occupational therapist can help you stay independent by talking to you about any problems you might have with everyday tasks and activities. They can help you find ways to make these as safe and easy as possible.
For example, an occupational therapist can help make your home and workplace safer and more manageable. They can give advice about appropriate aids and equipment, such as fixing extra hand rails by steps, stairs and in the bathroom.
An occupational therapist can also help you find different ways of doing everyday things like fastening buttons, eating or cooking. They can also provide advice on ways to continue working and joining in with social and leisure activities.
Occupational therapists can be contacted directly in some areas through your local social services or social work department, or by referral through your GP, specialist or Parkinson’s nurse.
Useful contacts for falls and dizziness
- Age UK Personal Alarms Service
- The Chartered Society of Physiotherapy
- Health & Safety Executive
- Inclusive Fitness Initiative from the English Federation of Disability Sport
- The Royal Society for the Prevention of Accidents (ROSPA)