Abstract
INTRODUCTION
People with Parkinson’s disease (PwPD) often report low levels of physical activity and poor health and 90% of PwPD will fall at least once[1]. Interventions to reduce falls in PwPD often involve physical therapy and exercise, however the environment is an independent risk factor for falls[2]. Exploring whether fall circumstances differ in PwPD due to health status and physical activity level will inform occupational health services and the design and development of environmental modifications.
METHODS
An online survey was developed to evaluate falls in adults ≥60y. Of 358 respondents, 117 were diagnosed with PD. The survey covered basic descriptors, fall history and contextual information about falls. Health (good/ average/ poor) and physical activity (active/ inactive) status were self-reported and used to stratify respondents.
RESULTS
68% of respondents with PD had fallen and of these 90% had poor health or were physically inactive. The 3 most problematic environments (steps/stairs, uneven/sloped surfaces and objects on the floor) and 4 most common pre fall activities (turning, walking, moving too quickly and transferring) were the same regardless of health or physical activity status, although more frequently reported by those with poor health or physically inactive.
Misjudging objects and falling over trip hazards was more common in PwPD of poor health than those of average/good health. Falls on steps and stairs were more common in physically inactive PwPD than those who were physically active.
CONCLUSION
This survey has highlighted several problematic aspects of the home environment contributing to falls in PwPD. Routine person-environment risk assessments are required to identify home hazards early. Research through co-design with PwPD and relevant stakeholders is required to develop novel home modifications targeting problematic environments so interventions may be prescribed effectively.
[1] Allen 2013 PMID:23533953 [2] van der Marck 2014 PMID:24484618
Comments
Question
Hello. Thank you for presenting your work. How would you go about assessing the impact of each of Fear of Falling, Co-mobidities and polypharmacy (including impact of different PD medications and at different doses) had on frequency of falls?
Hi Dr MacRae, Thank you for your comment.
All data regarding health, physical activity and fall events (including Co-morbidities etc) was self reported by participants of the online survey as outlined in the poster.
Fear of falling (FOF) was assessed using a short FES-I questionnaire which prompted respondents to rate their fear of falling (from not concerned at all to very concerned) during 7 different activities. These responses generated a score which quantified fear of falling for each respondent.
Both co-morbidities and medications were self reported by quantity and some participants continued further to provide a list of their co-morbidities but no specific medication data was collected.
We found fallers reported a significantly higher FOF then non fallers (p=0.001) yet the most frequent fallers (>20 reported falls) had a lower FOF than less frequent fallers (4-20 reported falls). Additionally, both co-morbidities (p=0.049) and use of 5 or more medications were reported more frequently in fallers compared to non fallers.
Unfortunately, no calculations were completed regarding the impact of co-morbidities and polypharmacy on the frequency of falls. However, I believe this analysis would be possible to some extent using the existing data set.