Falls and the causes of falls in Parkinson's

Some people with Parkinson’s find their gait becomes impaired, they may walk slowly, shuffle or suffer from freezing. All of these can compromise balance and falls become common - increasingly so as the condition progresses¹. Falls typically begin between five to 10 years after onset of the first symptoms.

Falls particularly happen when movement changes suddenly, for example when turning around, or when more than one thing is done at a time, such as carrying an item whilst walking.

But not everyone with Parkinson’s is susceptible to falls, although statistically people with Parkinson's are more likely to fall over than people without. Those who do fall find it tends to be forwards, and occasionally sideways, resulting in bruises, cuts, or even fractures and broken bones. This can cause distress and discomfort and impact on quality of life, so it is important to be aware of the likely causes of falls and learn ways to minimise risks.

 

What causes falls in Parkinson’s?

Postural instability and freezing are probably the greatest causes of falls. Reduced blood pressure (orthostatic hypotension), impaired eyesight and hazards in the home can also be contributing factors.

• Stooped posture - the stooped posture that often occurs as Parkinson’s progresses increases the risk of falling forwards because of the shift in the centre of gravity.
• Postural instability - the basal ganglia part of the brain, the part that is affected by Parkinson’s, controls walking and plays an important role in adjusting balance as we move. Because of the effect Parkinson’s has on the basal ganglia, some patients do not have the normal reflexes to quickly adjust position and maintain balance when a weight shift occurs. For example, some find themselves unable to reach their arms out for support when walking on an uneven surface or cannot take an additional short step to avoid falling when tripping.
  
  Moreover, because Parkinson’s causes muscles to stiffen and become rigid, many people find it hard to swing their arms to help keep balance when walking and feet may drag slightly. Posture can also become more stooped as muscle tone is affected and this too can increase the risk of falling.
• Freezing – this is a term to describe when you involuntarily suddenly stop walking or are unable to initiate a movement as your feet feel ‘glued’ to the floor. Freezing may last just a few seconds or for several minutes, and may make you feel unsteady and therefore more prone to falling.
  
  People with Parkinson’s often find it difficult to judge spaces and may struggle to navigate through doorways or narrow passages, resulting in freezing and an increased likelihood of falling.
• Reduced blood pressure (orthostatic or postural hypotension) - when we move from lying or sitting to standing up our blood vessels automatically adjust to keep blood pressure even. But sometimes this does not happen - perhaps as a result of dehydration, illness or medication side effects – and a feeling of light-headedness results as blood flow to the brain is reduced. This can lead to fainting and falls, around half a minute or so after changing position. So it is important to get up slowly and be alert to the possibility of faintness.
  
  Besides the drugs specifically to lower blood pressure, certain Parkinson’s medications, such as dopaminergic drugs, can also affect blood pressure. Make sure you discuss any faintness you feel with your doctor as your medication may need to be altered.
• Eyesight - sight impairments, due to poor glasses or cataracts for example, can lead to falls. It is therefore important that eyes and any visual aids are properly looked after and regularly checked so that vision is as clear as possible.
• Hazards in your home or work - many falls can be avoided with careful planning and organisation. Even the smallest hazard, like laundry left on the floor, can cause a fall and, of course, removing such hazard could prevent injury. An occupational therapist will be able to advise on ways to reduce risks in the home or at work.