699
Journal of Parkinson’s Disease 4 (2014) 699–703 DOI 10.3233/JPD-140438 IOS Press
Research Report
Risk Factors for Frequent Falls in People with Parkinson’s Disease Serene S. Paula,b,∗ , Natalie E. Allenc , Cathie Sherringtona,b , Gillian Hellerd , Victor S.C. Fungb,e , Jacqueline C.T. Closef,g , Stephen R. Lordf and Colleen G. Canningc a The
George Institute for Global Health, Sydney, NSW, Australia Medical School, The University of Sydney, Sydney, NSW, Australia c Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia d Statistics Department, Faculty of Science, Macquarie University, North Ryde, NSW, Australia e Movement Disorders Unit, Department of Neurology, Westmead Hospital, Westmead, NSW, Australia f Neuroscience Research Australia, UNSW, Randwick, NSW, Australia g Prince of Wales Clinical School, UNSW, Prince of Wales Hospital, Randwick, NSW, Australia b Sydney
Abstract. Fall frequency varies among individuals with Parkinson’s disease (PD). We aimed to determine whether risk factors that distinguish PD fallers from non-fallers are influenced by frequent falls. 205 people with PD participated in a 6-month prospective study. Factors in previously published fall risk models were analyzed for their associations with fall rates and frequent fallers. Fall history, freezing and impaired reactive balance were associated with fall rates and the proportion of frequent fallers (p < 0.05). These models were highly accurate in discriminating frequent fallers (area under curve 0.84–0.87). Interventions to manage freezing and reduce balance impairment may reduce fall frequency. Keywords: Parkinson disease, accidental falls, risk factors, postural balance
INTRODUCTION Falls are a significant problem for people with Parkinson’s disease (PD), with most individuals who fall, falling recurrently (≥2 falls per year) [1]. However, amongst recurrent fallers, there is a wide range of fall frequency [1, 2] with some individuals falling multiple times per day. It is therefore important to understand fall risk factors according to fall frequency [1], as individuals who fall occasionally may require a different approach to falls assessment, intervention and management, than individuals who fall frequently [2]. Only one study to date has investigated risk factors for high fall rates in people with PD, but it examined only cognitive factors [3]. ∗ Correspondence
to: Dr. Serene S. Paul, The George Institute for Global Health, Australia. Tel.: +61 2 9657 0300; E-mail: [email protected].
Recently we published multivariate models which successfully distinguished between PD fallers and non-fallers [4, 5]. The model predicting the likelihood of subsequent falls included a history of falls, a history of freezing of gait (FOG) and preferred gait speed
Journal of Parkinson’s Disease 4 (2014) 699–703 DOI 10.3233/JPD-140438 IOS Press
Research Report
Risk Factors for Frequent Falls in People with Parkinson’s Disease Serene S. Paula,b,∗ , Natalie E. Allenc , Cathie Sherringtona,b , Gillian Hellerd , Victor S.C. Fungb,e , Jacqueline C.T. Closef,g , Stephen R. Lordf and Colleen G. Canningc a The
George Institute for Global Health, Sydney, NSW, Australia Medical School, The University of Sydney, Sydney, NSW, Australia c Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia d Statistics Department, Faculty of Science, Macquarie University, North Ryde, NSW, Australia e Movement Disorders Unit, Department of Neurology, Westmead Hospital, Westmead, NSW, Australia f Neuroscience Research Australia, UNSW, Randwick, NSW, Australia g Prince of Wales Clinical School, UNSW, Prince of Wales Hospital, Randwick, NSW, Australia b Sydney
Abstract. Fall frequency varies among individuals with Parkinson’s disease (PD). We aimed to determine whether risk factors that distinguish PD fallers from non-fallers are influenced by frequent falls. 205 people with PD participated in a 6-month prospective study. Factors in previously published fall risk models were analyzed for their associations with fall rates and frequent fallers. Fall history, freezing and impaired reactive balance were associated with fall rates and the proportion of frequent fallers (p < 0.05). These models were highly accurate in discriminating frequent fallers (area under curve 0.84–0.87). Interventions to manage freezing and reduce balance impairment may reduce fall frequency. Keywords: Parkinson disease, accidental falls, risk factors, postural balance
INTRODUCTION Falls are a significant problem for people with Parkinson’s disease (PD), with most individuals who fall, falling recurrently (≥2 falls per year) [1]. However, amongst recurrent fallers, there is a wide range of fall frequency [1, 2] with some individuals falling multiple times per day. It is therefore important to understand fall risk factors according to fall frequency [1], as individuals who fall occasionally may require a different approach to falls assessment, intervention and management, than individuals who fall frequently [2]. Only one study to date has investigated risk factors for high fall rates in people with PD, but it examined only cognitive factors [3]. ∗ Correspondence
to: Dr. Serene S. Paul, The George Institute for Global Health, Australia. Tel.: +61 2 9657 0300; E-mail: [email protected].
Recently we published multivariate models which successfully distinguished between PD fallers and non-fallers [4, 5]. The model predicting the likelihood of subsequent falls included a history of falls, a history of freezing of gait (FOG) and preferred gait speed
