Clinical Summary: Falls and Parkinson's

This is a brief clinical summary on falls in Parkinson's, supported by a series of four Critically Appraised Topics (CATs), which are designed for clinicians caring for people with the condition. This summary outlines Parkinson's specific modifiable factors and evidence-based interventions.

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Risk factors and interventions for falls in older people (non Parkinson's population) are not covered but signposted below. The summary is supported by a series of Critically Appraised Topics (CATs), which are available on the UK Parkinson's Excellence Network online resource centre. These documents address 3 of the challenges identified in the 2015 UK Parkinson’s Audit:

  1. Integrated services.
  2. Standardised practices.
  3. Prevention of infections and falls.

The summary was devised in November 2016 and will be updated in 2019.

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  • Ask about falls and their frequency, context and characteristics.       .            
  • Use the simple clinical tool to predict falls (see Falls Assessment CAT).
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  • Cardiac causes.
  • Orthostatic Hypotension.
  • Cognitive impairment.
  • Fear of falling/depression/anxiety.
  • Gait and balance impairment, including focal neurology.
  • Muscle weakness.
  • Arthrosis.
  • Visual impairment/footwear.
  • Urinary incontinence.
  • Medication use (especially sedatives, psychotropic medications and cholinergic burden) and polypharmacy.
  • Home hazards.
  • Alcohol use.

See NICE guidelines for more information. 

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Factor Assessment Intervention

Freezing of gait

Ask patient

FOG questionnaire

Rapid 360 degree turn

Walking and talking

OT home assessment

Cueing and cognitive gait strategies                     

Environmental adaptation such
as use of visual cues

Optimise dopaminergic medications (ensure adherence)

Slow shuffling gait Examine walking speed and gait

Optimise dopaminergic
medications (ensure adherence)

Cueing techniques

Muscle strength training

Undertreated motor symptoms

Examination

UPDRS, H&Y

Optimise dopaminergic
medications (ensure adherence)
Dyskinesias

History

Examination

Home diary

Optimise dopaminergic
medications

Consider amantadine

Consider continuous
dopaminergic stimulation

Postural instability

Pull test

Berg Balance scale

Progressive resistance
strength training

Movement strategy training

Tai Chi

Turning strategies

Transfers

Examination of transfers

OT home assessment

Lying and standing blood pressure

Transfer training

Home adaptations and equipment

Rationalise antihypertensives: increase fluid intake, compression stockings/abdominal binding, consider midodrine/fludrocortisone 

Parkinsons-specific cognitive
impairment/impulsivity

History from patient and carer

Montreal Cognitive Assessment

Review and rationalise medications

Minimise hazardous behaviour

Consider cholinesterase inhibitors

Involve carers

Cueing strategies

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Not all causes of falls are modifiable ie age, gender, disease stage.

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Some interventions require periodic reassessments to ensure the patient is adequately treated.

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This clinical summary, and the related Critically Appraised Topics are the work of the Evidence-Based Practice Theme Working Group:

  • Lynn Rochester (Chair).
  • Kevin Galbraith.
  • Donald Grosset.
  • Mike Samuel.
  • Katherine Deane.
  • Debbie Davies.
  • Carl Clarke.
  • Janine Barnes.
  • Alison Yarnall.
  • Julia Johnson.

Clinical summary: Falls and Parkinson's (PDF, 71KB)

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