Journal of Neurology

, Volume 252, Issue 11, pp 1310–1315 | Cite as

Falls in outpatients with Parkinson's disease

Frequency, impact and identifying factors
  • Y. Balash
  • C. Peretz
  • G. Leibovich
  • T. Herman
  • J. M. Hausdorff
  • N. Giladi
ORIGINAL COMMUNICATION

Abstract

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 words

Parkinson's disease gait disorders falls urinary incontinence 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 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. 2.
    American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th ed. American Psychiatric Association:Washington, DCGoogle Scholar
  3. 3.
    Aranda B (1993) Vesical sphincter disorders in Parkinson disease. Rev Neurol (Paris) 149:476–480PubMedGoogle Scholar
  4. 4.
    Ashburn A, Stack E, Pickering RM, Ward CD (2001) A communitydwelling sample of people with Parkinson's disease: characteristics of fallers and Non–Fallers. Age Ageing 30:47–52CrossRefPubMedGoogle Scholar
  5. 5.
    Ashburn A, Stack E, Pickering RM, Ward CD (2001) Predicting fallers in a community based sample of people with Parkinson's disease. Gerontology 47:277–281CrossRefPubMedGoogle Scholar
  6. 6.
    Barry MJ, Fowler FJ Jr, O'Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, Cockett AT (1992) The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol 148:1549–1557PubMedGoogle Scholar
  7. 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
  8. 8.
    Bloem BR, Grimbergen YA, Cramer M, Willemsen M, Zwinderman AH (2001) Prospective assessment of falls in Parkinson's disease. J Neurol 248:950–958CrossRefPubMedGoogle Scholar
  9. 9.
    Brown JS, McGhan WF, Chokroverty S (2000) Comorbidities associated with overactive bladder. Am J Manag Care 6:S574–S579PubMedGoogle Scholar
  10. 10.
    Brown JS, Vittinghoff E, Wyman JF, Stone KL, Nevitt MC, Ensrud KE, Grady D (2000) Urinary incontinence: does it increase risk for falls and fractures? Study of Osteoporotic Fractures Research Group. J Am Geriatr Soc 48:721–725PubMedGoogle Scholar
  11. 11.
    Cummings SR, Nevitt MC, Kidd S (1988) Forgetting falls. The limited accuracy of recall of falls in the elderly. J Am Geriatr Soc 36:613–616PubMedGoogle Scholar
  12. 12.
    De Rekeneire N, Visser M, Peila R, Nevitt MC, Cauley JA, Tylavsky FA, Simonsick EM, Harris TB (2003) Is a fall just a fall: correlates of falling in healthy older persons. The Health, Aging and Body Composition Study. J Am Geriatr Soc 51:841–846CrossRefPubMedGoogle Scholar
  13. 13.
    Defreitas GA, Lemack GE, Zimmern PE, Dewey RB, Roehrborn CG, O'Suilleabhain PE (2003) Distinguishing neurogenic from non–neurogenic detrusor overactivity: a urodynamic assessment of lower urinary tract symptoms in patients with and without Parkinson's disease. Urology 62:651–655PubMedGoogle Scholar
  14. 14.
    Gelb DJ, Oliver E, Gilman S (1999) Diagnostic criteria for Parkinson's disease. Arch Neurol 56:33–39CrossRefPubMedGoogle Scholar
  15. 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
  16. 16.
    Giladi N, McDermott MP, Fahn S, Przedborski S, Jankovic J, Stern M, Tanner C; Parkinson Study Group (2001) Freezing of gait in PD: prospective assessment in the DATATOP cohort. Neurology 56:1712–1721PubMedGoogle Scholar
  17. 17.
    Gray P, Hildebrand K (2000) Fall risk factors in Parkinson's disease. J Neurosci Nurs 32:222–228PubMedGoogle Scholar
  18. 18.
    Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17:427–442PubMedGoogle Scholar
  19. 19.
    Hubble JP, Koller WC, Waters C (1993) Effects of selegiline dosing on motor fluctuations in Parkinson's disease. Clin Neuropharmacol 16:83–87PubMedGoogle Scholar
  20. 20.
    Koller WC, Glatt S, Vetere–Overfield B, Hassanein R (1989) Falls and Parkinson's disease. Clin Neuropharmacol 12:98–105PubMedGoogle Scholar
  21. 21.
    Kron M, Loy S, Sturm E, Nikolaus T, Becker C (2003) Risk indicators for falls in institutionalized frail elderly. Am J Epidemiol 158:645–653CrossRefPubMedGoogle Scholar
  22. 22.
    Lyness JM, Noel TK, Cox C, King DA, Conwell Y, Caine ED (1997) Screening for depression in elderly primary care patients. Arch Intern Med 157:449–454CrossRefPubMedGoogle Scholar
  23. 23.
    Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel index. Md State Med J 14:61–65PubMedGoogle Scholar
  24. 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
  25. 25.
    Michalowska M, Krygowska–Wajs A, Jedynecka U, Sobieszek A, Fiszer U (2002) Analysis of causes for falls in people with Parkinson's disease. Neurol Neurochir Pol 36:57–68PubMedGoogle Scholar
  26. 26.
    Pils K, Neumann F, Meisner W, Schano W, Vavrovsky G, Van der Cammen TJ (2003) Predictors of falls in elderly people during rehabilitation after hip fracture – who is at risk of a second one? Z Gerontol Geriatr 36:16–22CrossRefPubMedGoogle Scholar
  27. 27.
    Podsiadlo D, Richardson S (1991) The timed "Up and Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148PubMedGoogle Scholar
  28. 28.
    Sato Y, Manabe S, Kuno H, Oizumi K (1999) Amelioration of osteopenia and hypovitaminosis D by 1alpha–hydroxyvitamin D3 in elderly patients with Parkinson's disease. J Neurol Neurosurg Psychiatry 66:64–68PubMedCrossRefGoogle Scholar
  29. 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. 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
  31. 31.
    Wagner TH, Hu TW, Bentkover J, LeBlanc K, Stewart W, Corey R, Zhou Z, Hunt T (2002) Health–related consequences of overactive bladder. Am J Manag Care 8:S598–S607PubMedGoogle Scholar
  32. 32.
    Wood BH, Bilclough JA, Bowron A, Walker RW (2002) J Neurol Neurosurg Psychiatry 72:721–725 CrossRefPubMedGoogle Scholar

Copyright information

© Steinkopff-Verlag 2005

Authors and Affiliations

  • Y. Balash
    • 1
    • 2
  • C. Peretz
    • 1
    • 3
  • G. Leibovich
    • 1
  • T. Herman
    • 1
  • J. M. Hausdorff
    • 1
    • 3
    • 4
  • N. Giladi
    • 1
    • 2
    • 3
  1. 1.Movement Disorders UnitTel Aviv Sourasky Medical CenterTel Aviv 64239Israel
  2. 2.Dept. of NeurologySackler School of Medicine, Tel-Aviv UniversityTel-AvivIsrael
  3. 3.Dept. of Physical TherapySackler School of Medicine, Tel-Aviv UniversityTel-AvivIsrael
  4. 4.Division on AgingHarvard Medical SchoolBoston (MA)USA

Personalised recommendations