Prevention of Falling in patients with Parkinson's disease

I was in the emergency room being seen for a banged head.  I had fallen  after getting down from watering my hanging plants. (They are no longer hanging.) I said to the ER doc, “These falls are going to kill me.” He hesitated a moment, then looked at me and said, “Yes.”

I was diagnosed with Parkinson's disease in 2005, because I was not swinging my left arm as I walked, I stumbled and shuffled with my left leg, and I had a stare. I was tripping over things. And I was incredibly anxious. Ten years later, I am still mobile, but can no longer work. The main thing I am afraid of is falling.

The most serious side effects I have had from Parkinson's disease were caused by falls.

Falls have dislocated my right shoulder. Broken my right wrist. Not to mention bruising. I nearly had a compartment syndrome,  where a part of your body surrounded by connective tissue swells to the point where the arterial blood almost cannot get in to feed the tissues.

So do as I say, not as I do.

What do patients with Parkinson's (PWP's) die of? Often they are elderly, and die of something completely other than the Parkinson's, like cancer or heart disease. But if nothing else happens, there are two major Parkinson complications which can finish us off:
1. Fractures (particularly of the ankle, thigh, calf, hip or leg) which cause immobilization. Not moving enough predisposes the patient to developing pneumonia, bed sores, and other pleasures; and aspiration pneumonia. 
2. Aspiration means food or stomach contents get into the lungs, where they encourage the growth of the bacteria that then cause pneumonia.

The Quebec government did extensive research on falls in the elderly (1).  Thirty percent of regular folks over 60 fall and injure themselves in a given year, and 50% of those over 80 fall. Falls are the most common cause of death in the elderly, outside of death from a pre-existing chronic disease. If the person is not found immediately after the fall he may become dehydrated and his kidneys may fail, or he may develop skin lesions due to pressure from the ground or floor. Only half of those who break a hip will be able to walk again, and 20% die in the subsequent year.

The elderly fall because of weakened muscles and poor balance. PWP even more so. Balance and co-ordination are particularly affected by Parkinson's disease. So exercise, especially exercise that challenges your balance, is very important. In early Parkinson's disease, exercise may delay the effect on the body of the Parkinson's disease.  In more advanced Parkinson's, exercise actually increases the risk of falls, but it is a balancing act (pun intended), because if you stop moving, you lose the ability to move. Tai chi: falls reduced by 24%.ⁱ

Next, get your eyes checked. Removal of a cataract, or more precise corrective lenses, may save your life. Correct vision: falls reduced by 34%.

Adapt your house to your reduced agility. Put banisters on both sides of all your stairs, and hold onto them on your way up and particularly down the stairs. Provide lighting on stairs and hallways. Put bars around the bath and toilet to steady you getting in and out of the bath and onto and off the toilet. Reduces falls by 20%.

A second banister has been added to the wall side of the stairs, allowing me to hold on going up or down the stairs.  It is firmly fixed to an anchoring block attached to the wall at the studs. It matches the oak of the stairs well enough to blend with the style of the house, and so will not necessarily need to be removed when it is no longer needed.

Stairs if they are bare wood should be varathaned with a special varathane for stairs, which has a rough surface.  If carpeted, the surface of the carpet should be rough.

In the bathroom it is important to have grab bars so you can hold on while you are showering, and getting in and out of the bath.  For traction on the bottom of the bath a bath mat or stickers helps.  Grab bars made of stainless steel helps to avoid unsightly corrosion.  Our towel rail (not shown) is also installed as a grab bar.

The railings on the wall were installed during my first pregnancy, and are useful to hold on to when I stand in the shower and in getting out of the bath.  The railing on the edge of the bath is useful to steady me when I get in and out of the tub. 

Remove all loose rugs and obstacles from the house. Don't put your knitting on the floor by your feet where the wool will tangle round your ankles and trip you when you get up.

Vitamin D and calcium will help your bone health. In addition I have read that vitamin D reduces falls by 19%.

Review your medications with your doctor. Do you need them all? Are some of them sedatives, that could make you more likely to fall? Cut out the ones you don't really need. Particularly avoid benzodiazepines which can build up in the blood of the elderly, and of course avoid alcohol. Reduce falls by 27%.

Get boots with crampons, or crampons to go on your boots when it is icy. (Better still, avoid walking outside when it is icy.) Be aware that you can't wear some types of crampons inside buildings, because they will actually make you slip on the hard floor, whereas they dig into ice. Reduce falls by 58%.

Those numbers are for the elderly in general. In PWP, the situation is aggravated by rigidity of the muscles from the Parkinson's, and abnormal movements, or dyskinesias, due to the medications given for Parkinson's, which can throw you out of balance. Fear of falling also causes falls. “Freezing” with sudden stops, may also cause falls. There are a number of techniques to avoid freezing.

On the icy streets of Montreal it is easy to fall. 

 Stairs are another thing. Many homes here have outside staircases to get to the second or third floor apartment or condo (I.e. one or two floors above the ground floor) . For all staircases, it is critical to remove the snow and ice, and lay an abrasive or salt according to the outdoor temperature. If necessary you should hire someone to do this for you before you go out the door. If you are a PWP, you should not do it yourself.

The shoes you wear indoors or outdoors are very important. The soles should not slip, nor stick too much. If they have laces, make sure they stay done up. One of my worst falls was due to stepping on the laces of one boot with the other foot. Better still, get shoes with velcro closures, and get rid of the laces altogether. Stocking feet are not a good plan, unless you want to fall down the stairs. Get a good pair of slippers or shoes for indoors.

I find that my slippers, which tend to have a rough surface on the upper part, catch on the fabric of the other leg of my trousers when I go down stairs.  This delays the lifted leg from finishing the step, and if I was not holding onto a railing I would go headfirst down the stairs. I nearly did that yesterday.  And I fell down the six concrete steps at the optician's, as there was no railing and my foot caught on the rough concrete on the top step. So put a bicycle clip on loose trouser legs, or find other footwear which will not grab the fabric. 

What has caused my falls?

I got angry and stood up on my foot-stool, then lost balance and fell and hit my head and dislocated my shoulder. Denied hitting my head in the ER or later, until months afterwards I heard myself saying “When I came to after my fall….”

At boxing class, did a dance step with too much enthusiasm. “Punch, punch, pivot….” Pivoted back on my outstretched hand and broke my wrist.

So don't get angry. Or, to be more realistic, don't move in anger. Don't run to catch the doorbell or the phone. And contain your enthusiasm.

Know that you can't protect yourself by wrapping yourself in cellophane – life is to be lived! To the end!

Reference:

1. Gagnon C., Lafrance M. (2011) Prévention des chutes auprès des personnes âgées vivant à domicile. Analyse desdonnées scientifiques et recommandations préliminaires à l’élaboration d’un guide de pratique clinique. Institut national

de santé publique du Québec, juin 2011.

I prepare a summary of a medical area related to Parkinson's disease for my support group each  month, and will publish essays here based on these reviews.  These essays are intended to help readers make informed decisions about their health and the health of their loved ones. 

Information contained here is not intended to be a substitute for treatment by or the advice and care of a professional health-care provider.  While the author has endeavored to ensure that the information presented is accurate and up-to-date, she is not responsible for adverse effects or consequences sustained by any person using this blog.