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Blog: Thinking about falls

Louise, who has Parkinson's, at home in Brighton

Geriatrician Sally Jones talks about how joint working between geriatrics and neurology colleagues has created a resource to help both better serve people with Parkinson’s who fall. Geriatrician Sally Jones

Did you know that 60% of people with Parkinson's fall every year, and that a significant proportion of these do so recurrently (Allen, Schwarzel and Canning, 2013)?

As a geriatrician, I see many people who fall recurrently, both with Parkinson's and without. There are many consequences of falls, but one heart-breaking thing people sometimes tell me is that they are so frightened of falling that they no longer want to leave the house, or sometimes even choose to go into residential care.

As professionals, we've got to try to do something about this. Parkinson's can be difficult enough to live with without feeling like this too. 

Preventing falls

So what can we do to help prevent falls in people with Parkinson's? And what 'damage limitation' measures can we put in place for people who continue to fall despite this?

As a geriatrician, it is clear to me that much of what applies to older people without Parkinson's who fall, also applies to people of any age with Parkinson's. This is in addition to all the Parkinson's-specific falls risks and interventions.

As professionals, we've got to try to do something about this. Parkinson's can be difficult enough to live with without feeling like this too.

However, from talking to my neurology colleagues at the West Midlands Parkinson's Network, it became clear that though they are very skilled at the Parkinson's-specific elements to falls, some are less confident than the geriatricians about the more generic falls risks and interventions - for example in addressing bone health.

A new resource 

We decided as a network to try to do something about this. We're aware of the fantastic work that the wider Excellence Network is undertaking and that the Evidence Based Practice theme working group is meeting to formulate a clinical summary on the assessment and management of falls.

We didn't want to duplicate this, but still wanted to pull together some tips and resources that could be of help to clinicians in the region – not just for doctors and specialist nurses, but something that would be useful for our therapy colleagues too.

With the input of our colleagues in networks elsewhere in the UK (Veronica Lyell and Emily Henderson), we pulled together a short document of Tips and Resources aiming to do this.  

Tips and advice

The Tips and Resources document lists potentially modifiable risk factors for teams to consider when assessing people with Parkinson's who fall, and then gives a 1-page flow chart – an 'aide memoire' for further assessment.

The Tips and Resources document lists potentially modifiable risk factors for teams to consider when assessing people with Parkinson's who fall, and then gives a 1-page flow chart – an 'aide memoire' for further assessment.

We also included Veronica Lyell and Emily Henderson's previously published algorithm for assessing bone health in people with Parkinson's as well as links to some useful multi-disciplinary resources. We've compiled a separate West Midlands regional directory of services for people who fall too, and now need to find a way of making this directory easily accessible and up to date.  

We've sent the Tips and Resources document electronically to all the people on the West Midlands Network mailing list and are looking forward to receiving feedback at our next meeting later this year.

We're hopeful that thinking more carefully about falls will be one more thing we can all do to help.

Sally Jones is a consultant geriatrician and physician with specialist interest in Parkinson's at Heart of England NHS Foundation Trust. You can follow Sally on Twitter at @sallyjones1976.