In May, the Parkinson’s lecture series hosted by Charco continued with a talk on the risk of falls presented by Dr Viktoria Azoidou. Viktoria is a neuro-vestibular Physiotherapist and clinical research associate at Charco. In this post, we share some of Viktoria’s advice that can help people with Parkinson’s to reduce their risk of falls.
In this post, Viktoria has concentrated some information that is given by various associations in the UK including Parkinson’s UK, Parkinson’s Foundation, Chartered Society of Physiotherapy and Association of Chartered Physiotherapists Interested in Vestibular Disorders to help people with Parkinson’s reduce their risk of falling.
A person’s risk of falling can increase with Parkinson’s, with 7 in 10 people with Parkinson’s likely to fall this year. Reducing the frequency and severity of these incidents is vital for the independence, emotional well-being and overall quality of life of people with Parkison’s. The first step in understanding your safety is assessing your risk of falling.
Viktoria summarised Parkinson’s UK’s guidance on things that may increase a person’s fall risk:
- A previous fall
- A tendency to trip
- Not eating well and/or drinking enough fluids
- Not staying as active as doctors recommend
- Feeling unsteady when walking
- Experiencing freezing episodes
- Feeling dizzy, weak, or fatigued
- Taking medication that may affect balance or cause dizziness
- Not having reviewed one’s medication with a GP for the past year
- Depending on a mobility aid but sometimes neglecting to use it
- Frequent nighttime bathroom visits
How Parkinson’s Affects the Balance System
Experiencing side effects from Parkinson’s medications or difficulties with movement symptoms puts you at a higher risk of falling.
Blood pressure changes and medication side effects can lead people with Parkinson’s to experience dizziness. With over 75% of people over 75 taking three or more medications a week, the likelihood of experiencing adverse side effects is increased. This risk is on top of the movement symptoms that affect 60% of people with Parkinson’s.
You can learn more about dizziness from this post by Parkinson’s UK.
If you are experiencing dizziness, Viktoria recommend not to stop taking medication without first discussing it with your clinician. If you suspect a medication is causing dizziness, she recommends that you discuss the following questions with a medical professional:
The Association of Chartered Physiotherapists Interested in Vestibular Rehabilitation (ACIPVR) have developed a memorable acronym, TREND
- Timing: Did symptoms start around the time of a new medication? Are you taking medication that causes side effects over time (e.g. opioids/antiepileptics)
- Re-challenge: If you take the medication again do the side effects occur?
- Experience: Have you had the medication before and did you experience any adverse reactions?
- Nature: Are the symptoms recognised as side effects of the medication which you believe is causing dizziness?
- De-challenge: Do the symptoms resolve when the medication is stopped?
This information and further details from the ACIPVR about medicine and dizziness can be read at this link.
Understanding the impact of falls
The injuries that you may experience from a fall depend on the way that you fall and impact the ground. Viktoria summarises for us the findings of a study into fall direction (Youn et al., 2017), you can read the full scientific article at this link.
- Falling forward is often caused by a freezing gait, something to be aware of when turning. These types of falls may be very dangerous as they more commonly result in fractures.
- Falling backwards or sideways, while usually less severe, is far more likely to happen while you are standing or sitting. Viktoria explains that both movement and psychiatric symptoms can affect your ability to manage how your weight is placed through your feet. Body weight positioning is key to balance and so anything that limits this ability increases your risk of falling.
The consequences of a fall can impact your life in many different ways. Viktoria presents to us information related to a study about Parkinson’s risk factors (Pelicioni et al., 2019), you can read the full article at this link. Beyond getting injured and possible hospital admission, falls can lead to a longer-term impact on your quality of life. The following are some examples of things to be aware of:
- Financial burden
- Mobility
- Fear of falling and loss of confidence can prevent people from moving as much as they should, or from leaving their homes
- Reduced independence
- Dependence on others
- Social isolation, which can affect one’s mood and emotional state
- Risk of another fall
Research shows that anyone can take action to decrease their risk of falling, regardless of their age or whether they have Parkinson’s.
You have the power to decrease your risk of falls.
By making small changes, starting daily activities and speaking to your doctor or Parkinson’s Nurses, you can ensure you are well informed about your health while improving your well-being.
Viktoria summarised information from The Chartered Society of Physiotherapy to help lower the risk of falling with some simple to-do lists. This printable sheet includes two ‘to-do’ guides, one you can start today, including further daily activities, and another to get done in the next month.
The full article from The Chartered Society of Physiotherapy can be read at this link.
Moving With Safety
The essential take away is: “Be cautious, but don’t make it the aim of your life”.
Worrying about falls too much is not good – this can lead to spending long periods sitting down, which may harm your confidence, balance, and mobility, which makes a fall even more likely.
Similarly, when a person is kept in bed whilst in hospital because of fall risk, they may rapidly de-condition and develop further problems.
To keep on top of this, you could think about the following when walking, experiencing freezing, and trying to sleep.
Here are some tips that are good to think about every time you are walking or experiencing freezing:
The importance of sleep cannot be overstated. Letting your body rest helps prepare you for the next day. Viktoria recommends keeping in mind the following advice from ACPIVR:
Further details from ACIPVR can be found at this link.
Confidence and Exercise
Building up an exercise routine not only keeps you strong but also builds confidence in how you move.
Before you start exercising, it is important to remember the following when you get active:
- If you use support, make sure it is sturdy and can support your body weight
- Wear supportive shoes
- A slight soreness the day after is quite normal
- Make sure you are on your ON period
- If, at any time, you are feeling unsafe to exercise on your own, please have someone with you
- If you experience dizziness, palpitations, nausea, chest pain, shortness of breath, or fainting, stop and call your GP or 111
Parkinson’s Foundation offers a full guide on staying active, with information on different types of exercise ideal for maintaining your health as a person with Parkinson’s.
What to do if you fall?
We are now all clued up on the dangers of falling and how to reduce the risk. This, however, does not mean they will never happen. In the unfortunate event that you have fallen, it is important to know the next steps.
You can print Viktoria’s advice on how to cope with a fall from the section below.
More information on preventing falls for people with Parkinson’s can be found at the following links that Viktoria has provided:
Thank you very much to Viktoria for her talk on fall prevention as a person with Parkinson’s. To keep up to date with future Charco lectures and upcoming events, you can sign up to our newsletter here.