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.
Similar content being viewed by others
References
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
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th ed. American Psychiatric Association:Washington, DC
Aranda B (1993) Vesical sphincter disorders in Parkinson disease. Rev Neurol (Paris) 149:476–480
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 30:47–52
Ashburn A, Stack E, Pickering RM, Ward CD (2001) Predicting fallers in a community based sample of people with Parkinson's disease. Gerontology 47:277–281
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 148:1549–1557
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)
Bloem BR, Grimbergen YA, Cramer M, Willemsen M, Zwinderman AH (2001) Prospective assessment of falls in Parkinson's disease. J Neurol 248:950–958
Brown JS, McGhan WF, Chokroverty S (2000) Comorbidities associated with overactive bladder. Am J Manag Care 6:S574–S579
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 48:721–725
Cummings SR, Nevitt MC, Kidd S (1988) Forgetting falls. The limited accuracy of recall of falls in the elderly. J Am Geriatr Soc 36:613–616
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 51:841–846
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 62:651–655
Gelb DJ, Oliver E, Gilman S (1999) Diagnostic criteria for Parkinson's disease. Arch Neurol 56:33–39
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)
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 56:1712–1721
Gray P, Hildebrand K (2000) Fall risk factors in Parkinson's disease. J Neurosci Nurs 32:222–228
Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17:427–442
Hubble JP, Koller WC, Waters C (1993) Effects of selegiline dosing on motor fluctuations in Parkinson's disease. Clin Neuropharmacol 16:83–87
Koller WC, Glatt S, Vetere–Overfield B, Hassanein R (1989) Falls and Parkinson's disease. Clin Neuropharmacol 12:98–105
Kron M, Loy S, Sturm E, Nikolaus T, Becker C (2003) Risk indicators for falls in institutionalized frail elderly. Am J Epidemiol 158:645–653
Lyness JM, Noel TK, Cox C, King DA, Conwell Y, Caine ED (1997) Screening for depression in elderly primary care patients. Arch Intern Med 157:449–454
Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel index. Md State Med J 14:61–65
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) 108:128–132
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 36:57–68
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 36:16–22
Podsiadlo D, Richardson S (1991) The timed "Up and Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148
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 66:64–68
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
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 14:131–139
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–S607
Wood BH, Bilclough JA, Bowron A, Walker RW (2002) J Neurol Neurosurg Psychiatry 72:721–725
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Balash, Y., Peretz, C., Leibovich, G. et al. Falls in outpatients with Parkinson's disease. J Neurol 252, 1310–1315 (2005). https://doi.org/10.1007/s00415-005-0855-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-005-0855-3