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:
- Integrated services.
- Standardised practices.
- Prevention of infections and falls.
The summary was devised in November 2016 and will be updated in 2019.
- Cardiac causes.
- Orthostatic Hypotension.
- Cognitive impairment.
- Fear of falling/depression/anxiety.
- Gait and balance impairment, including focal neurology.
- Muscle weakness.
- 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.
Freezing of gait
Rapid 360 degree turn
Walking and talking
OT home assessment
Cueing and cognitive gait strategies
Environmental adaptation such
Optimise dopaminergic medications (ensure adherence)
|Slow shuffling gait||Examine walking speed and gait|| |
Muscle strength training
|Undertreated motor symptoms|| |
|Optimise dopaminergic |
medications (ensure adherence)
|Postural instability|| |
Berg Balance scale
Movement strategy training
Examination of transfers
OT home assessment
Lying and standing blood pressure
Home adaptations and equipment
Rationalise antihypertensives: increase fluid intake, compression stockings/abdominal binding, consider midodrine/fludrocortisone
|Parkinsons-specific cognitive |
History from patient and carer
Montreal Cognitive Assessment
Review and rationalise medications
Minimise hazardous behaviour
Consider cholinesterase inhibitors
Not all causes of falls are modifiable ie age, gender, disease stage.
Some interventions require periodic reassessments to ensure the patient is adequately treated.
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.