People living with Parkinson’s experience falls due to balance & mobility issues, becoming more pronounced as the condition progresses.

The fear of falling and associated loss of confidence may be as disabling as the actual falling and severely affect your quality of life. Preventing falls is essential to avoid serious injuries and maintain independence and wellbeing.

Understand the causes of falls to reduce your risk

Falling and loss of balance are common problems for people living with Parkinson’s. These problems develop over time as the condition progresses. For some people, falling may be a daily occurrence and may even occur several times in one day. Note – if falls, particularly falling backwards, occur soon after diagnosis, it may point towards atypical parkinsonism. Consult your GP or neurologist if concerned.

Engaging in regular exercise to improve strength and balance can optimise physical ability, improve mobility and reduce the risk of falls. Learning to identify fall hazards, particularly at home, and how to walk safely will also help reduce the risk of falling.

Possible causes of falls

There are numerous factors which increase the risk of falling in people with Parkinson’s. Many of these are associated with impaired movement. These include poor balance (postural instability), freezing of gait, shuffling when walking (festination), leg muscle weakness, slowed movement and a stooped posture.

Other non-motor factors that can contribute to falls include vision problems, sleep disturbance, impaired cognition and urinary urgency.

Medications taken to manage Parkinson’s and other conditions may increase the risk of falling. As the condition progresses, some people experience  dyskinetic movements (unwanted and uncontrolled movements on the extremities) after taking their Parkinson’s medications, and these can increase the risk of falling.  In addition, some people experience orthostatic hypotension, which results in lightheadedness and dizziness when changing positions, such as rising from a sitting position. Confusion and drowsiness can result from medications and increase the risk of falling.

Environmental hazards such as improper shoes, pets, poor lighting, uneven flooring, uneven ground, and pathways may also cause falls.

Prevention of falls

Understanding which factors contribute to falls is important since each is treated differently. Discussing any medical causes of falling with the GP or treating medical specialist will identify any.

Medications

Treating doctors can review medications. Optimising Parkinson’s medications can improve mobility and reduce freezing of gait and dyskinesias, thereby reducing fall risk.  Medication management should include:

  • Some medications can interact and contribute to falling. Discuss whatever you are taking (e.g. vitamins, supplements, meds) with your Parkinson’s Nurse Specialist or your pharmacist to look for potential interactions.
    • Always take medications on time as prescribed by your treating specialist.
    • Ensure the GP and treating specialist are aware of all medications taken (prescription and non-prescription).
    • Medications can also be prescribed to improve bone density and therefore reduce the chance of fractures when osteoporosis (thinning of the bones) is present. GPs can also arrange for bone density testing which is done via a quick and painless x-ray scan.

Vision problems

Improving visual problems is another way to prevent falls since eye problems are common in Parkinson’s.

  • Being active, keep moving and looking around, exercising and socialising is important to eye health. It can boost blinking and minimise dryness.
  • Maintain regular eye checks and speak to your ophthalmologist about any drops or strategies that are right for you.
  • Wear multifocal glasses with care, especially on stairs and when undertaking outdoor activities. Two pairs of glasses (long-distance and reading glasses) are recommended instead to avoid the confusion caused by walking with multifocals.

Physical and environmental causes

Referral to a  physiotherapist, an occupational therapist and an exercise physiologist can address the physical and environmental causes of falling. These health professionals can also assist with teaching the safest and easiest way to get up following a fall.

Get a home safety assessment by an occupational therapist or visit stopfallsathome.com.au website for an online version of a home self-assessment. Some things that you can do to reduce tripping and slipping hazards:

  • Reduce clutter to eliminate trip hazards.
  • Remove rugs, furniture, and other potential obstacles to walking.
  • Create unobstructed walkways throughout the home.
  • Ensure good overhead lighting, particularly at steps.
  • Use night lights where necessary, especially near bathrooms, for night time access.
  • Consider installing handrails at steps and grab rails in bathrooms (minor home modifications could be funded by NDIS or My Aged Care).
  • Consider installing anti-slipping mats in showers to avoid slipping.
  • Apply strips of tape to the floor in areas where freezing of gait occurs.
  • Avoid rolling chairs.

Key Statistics

  • Falls are common in people with Parkinson’s, with a high incidence rate of 40% to 70%. (1,2)
  • Exercise training can improve balance and walking in people with Parkinson’s and decrease their fall rates over both the short- and long-term. (3)

Exercise for falls prevention

A physiotherapist or accredited exercise physiologist can prescribe exercises designed to reduce your risk of falling. These can be done as part of a broader exercise program that includes aerobic exercise too. Depending on your preferences and needs, fall prevention exercises can be done individually or in class. They should be updated regularly (every 6 to 12 months or sooner if required) to ensure they are appropriate, challenging, and safe. They can be done seated or standing, adjusted for your level of mobility.

  • Balance exercises should be completed at least three times per week, but preferably daily. These can take many forms, including activities such as Tai Chi, dancing or non-contact boxing.
  • Leg strengthening exercises should be completed on three non-consecutive days per week.
  • Strategies to help manage freezing of gait, such as using cues (e. g., floor markers, walking to the beat of a metronome or music, or concentrating on taking big steps) should be practiced at least three times per week, but preferably daily, by people who experience freezing.

Improving walking safety

In addition to exercise, a physiotherapist can help you to move and turn around more safely.  If you are having problems with falls or near misses, safer mobility strategies might help. For example:

  • Slow down and concentrate on your movement.
  • Before you begin walking, pause to ensure you have your balance and check for hazards in the environment.
  • Avoid doing two things at once, such as talking while walking. Focus only on your walking.
  • Focus on taking big steps and lifting your feet from the ground.
  • Turn by stepping around in an arc – avoid pivoting.
  • If you have problems with freezing of gait, be prepared to use strategies to prevent freezing.
  • Wear supportive footwear.
  • Use walking aids to maximise stability if prescribed.

Technology and falls

It is important that you can call for help after a fall if you are injured or cannot get up. Ensure that you have someone who can regularly check in on you if you live alone and wear a medical alert bracelet or pendant alarm system in case there is a problem when you are out. You may be eligible for a support worker, and/or a personal alarm system, paid for through My Aged Care CHSP or the NDIS.

However, alarm systems can also be purchased privately through providers. Consider purchasing technology that uses artificial intelligence (AI) to detect falls:

  • pendant alarm system
  • smart watch with fall-detection and alarm technology
  • phone apps.

What to do if a fall occurs

  • Remain calm.
  • Do not attempt to move quickly.
  • Feel and look for any signs of pain or possible injuries prior to planning how to get up.
  • Carers and family members should avoid lifting someone who has fallen. This can result in the risk of injury to the carer or the person with Parkinson’s.
  • Use a heavy piece of furniture to help you get up. A carer or family member may need to bring a chair that you can use to help you get up.
  • If injured (or there is a fear of injury) try to stay as comfortable as possible.
  • Call for help using your chosen technology. If you are alone, you may need to crawl or scoot to a phone and call for help.
  • Call 000 if you are injured and/or need help.

The Preventing Falls and Harm from Falls in Older People: Best Practice Guidelines are now available

The Australian Commission on Safety and Quality in Health Care worked with researchers from NeuRA,  the NHMRC – funded Centre for Research Excellence for the prevention of falls injuries,  the University of Sydney, Flinders University  and the Australia and New Zealand Fall Prevention Society to update the guidelines which were originally published in 2009. Based on the latest scientific evidence across 3 settings – hospitals, residential aged care and community care, the Guidelines focus on interventions to support prevention. You can access the guidelines here: https://www.anzfallsprevention.org/resources/fall-prevention-guidelines/

Infosheet kindly reviewed by Occupational Therapy Australia & ANZ Falls Prevention Society

Australia’s professional association and peak body for occupational therapy, Occupational Therapy Australia (OTA) fosters evidence-based practice, enables lifelong learning and promotes the future of occupational therapy. OTA exists to support occupational therapists to support their community. To find an OT go to: www.otaus.com.au

Australian and New Zealand Falls Prevention Society (ANZFPS) was formed in 2006 to promote the multidisciplinary study and implementation of falls prevention in older people. www.anzfallsprevention.org

References:

(1) Bloem, B. R., Grimbergen, Y. A., Cramer, M., Willemsen, M., & Zwinderman, A. H. (2001). Prospective assessment of falls in Parkinson’s disease. Journal of neurology, 248, 950-958.

(2) Ashburn, A., Stack, E., Ballinger, C., Fazakarley, L., & Fitton, C. (2008). The circumstances of falls among people with Parkinson’s disease and the use of Falls Diaries to facilitate reporting. Disability and rehabilitation, 30(16), 1205-1212.

(3) Shen X, Wong-Yu ISK, Mak MKY. Effects of Exercise on Falls, Balance, and Gait Ability in Parkinson’s Disease: A Meta-analysis. Neurorehabilitation and Neural Repair. 2016;30(6):512-527. doi:10.1177/1545968315613447

Gupta, Parul, Neha Jain, and S. K. Meena. “Enhancing Quality of Life in Parkinson’s Disease: A Systematic Review of Occupational Therapy Interventions on Balance and Reaction Time.” Journal of Complementary and Alternative Medical Research 23, no. 4 (2023): 24-32.

Sturkenboom, I. H., M. J. Graff, J. C. Hendriks, Y. Veenhuizen, M. Munneke, and B. R. Bloem. “Occupational Therapy for Patients with Parkinson’s Disease.” 50 Studies Every Occupational Therapist Should Know (2023): 59.

Other resources:

World guidelines for falls prevention and management for older adults: a global initiative. https://worldfallsguidelines.com/

ParkinsonNet Occupational therapy guidelines www.parkinsonnet.com/guidelines

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