Falls in outpatients with Parkinson's disease
Falls are one of the most serious complications of gait disturbances in patients with Parkinson's disease (PD). Among previous reports, the percentage of patients with PD who fall varies between 38% to 68%. We sought to determine the frequency of falls and the factors associated with falls in a group of patients with idiopathic PD who attended an outpatient, tertiary movement disorders clinic. 350 ambulatory, non–demented patients (230 males) were studied. Mean age was 69.7 ± 10.6 years (range: 43–97 yrs) and mean duration of PD symptoms was 8.6 ± 6.2 years (range: 1–33 yrs). Assessments included characterization of demographics, disease duration, disease severity as measured by the Hoehn and Yahr Scale (H&Y), co–morbidities, the presence of depressive symptoms, the presence of urinary incontinence, use of anti–parkinsonian medications, and two performance–based tests of balance and gait (tandem standing and Timed Up & Go). Fall history was determined during three time periods: previous week, previous month, and previous year. Univariate and multivariate logistic regression models were applied to evaluate the relationship between the above–mentioned factors and falls. 46% of the subjects reported at least one fall in the previous year and 33% reported 2 or more falls and were classified as Fallers. Fallers had significantly more prolonged and advanced PD compared with Non–fallers (p = 0.001 and p < 0.001, respectively). Urinary incontinence was the factor most closely associated with falls (crude and adjusted OR were 1.95 and 5.89, respectively). Other factors significantly associated with fall status included increased Timed Up & Go times and increased PD duration. These findings confirm that falls are a common problem among patients with advanced PD and suggest easily measurable features that may be used to prospectively identify those PD patients with the greatest risk of falls.
Key wordsParkinson's disease gait disorders falls urinary incontinence
Unable to display preview. Download preview PDF.
- 1.A report of the Kellogg International Work group on the prevention of falls by the elderly. The prevention of falls in later life (1987) Dan Med Bull 34 (Suppl 4):1–24 Google Scholar
- 2.American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th ed. American Psychiatric Association:Washington, DCGoogle Scholar
- 7.Balash Y, Hausdorff JM, Giladi N (2005) Clinical evaluation and treatment of gait disorders in Parkinson's disease. In:Manuchair E, Pfeiffer R (eds) Parkinson's Disease. CRC Press LLC (in press)Google Scholar
- 15.Giladi N, Hausdorff J, Balash Y (2005) Episodic and Continuous Gait Disturbances in Parkinson's disease. In: Hausdorff JM, Alexander NB (eds) Evaluation and management of gait disorders. Marcel Dekker Inc. (in press)Google Scholar
- 24.Mendez Rubio JI, Zunzunegui MV, Beland F (1997) The prevalence of and factors associated with falls in older persons living in the community. Med Clin (Barc) 108:128–132Google Scholar
- 29.Shoulson I, Oakes D, Fahn S, Lang A, Langston JW, LeWitt P, Olanow CW, Penney JB, Tanner C, Kieburtz K, Rudolph A; Parkinson Study Group (2002) Impact of sustained deprenyl (selegiline) in levodopa–treated Parkinson's disease: a randomized placebo–controlled extension of the deprenyl and tocopherol antioxidative therapy of parkinsonism trial. Ann Neurol 51:604–612 CrossRefPubMedGoogle Scholar
- 30.Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA (1995) Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourol Urodyn 14:131–139PubMedGoogle Scholar