Wednesday, June 12, 2024
Wednesday, June 12, 2024
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Parkinson’s Disease Falls Risk

S For Preventing Falls Among Your Older Loved Ones

Falls Prevention in Parkinson’s

The six things caregivers can do to prevent falls starts with enlisting the help of the person at risk for falling. This webpage will tell you how and why you should ask about current health conditions, most recent eye checkup, medications, and notice if trouble standing or holding onto things or people while walking. Finally, it shares how to make a home a bit safer from falls.

How Can I Help Myself

It is important that you do not allow a fear of falling to stop you doing things, provided that you are sensible. Keeping active is good for your mobility and independence, and doing the things you like is good for your morale. Try not to let falls curb your activities too much as this can have a negative impact on your quality of life.

The following information and practical suggestions may help you in adapting your daily routine so as to minimise the risk of falls:

Inclusion And Exclusion Criteria

Quantitative systematic reviews , mixed-methods systematic reviews , or pooled analyses and research syntheses investigating the effectiveness of non-pharmacological falls prevention interventions for people with MS, PD and stroke were considered for inclusion in this umbrella review. Reviews published in the English language were included and authors of potentially relevant reviews published in a different language were contacted to ascertain if a copy of the review was available in English. No restriction was placed on year of publication of the review. In instances where a systematic review was an update of a previous review, the most recent version was included and the older version excluded. For the purposes of this umbrella review, a review was classified as an update of a previous version if there were changes pertaining to new data, new methods, or new analyses, but the research question, objectives and inclusion criteria remained similar . In the case of new authors or a different research team updating an existing review, they had to clearly state that their review was an update and acknowledge the work of the authors on the previous edition .

The eligibility criteria based on population, intervention, comparator, outcome and study design are outlined below.

Population

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Why Is Fall Prevention So Important

Oftentimes a fall will cause no injury or a mild, easily reversible injury, however, sometimes a fall can cause moderate to significant injury.

In addition to the fall itself potentially causing a fracture or head injury, the fall could possibly result in an ER visit, hospital stay, or surgery, which can sometimes set off a series of events that has the possibility of worsening a persons PD even more substantially. Hospitalizations can interfere with medication timing, contribute to simultaneous infection, precipitate hallucinations, and increase confusion. Each of these setbacks can spawn additional setbacks which can contribute to the worsening of PD overall. In addition, immobilization after a fracture can interfere with exercise and physical therapy goals. For all of these reasons and more, it is important to do all that you can to reduce the chance of falls.

Walking Freezing And Falling

Reducing Your Risk of Falling With Parkinsons Disease

The dopamine in your brain is heavily involved in controlling the movement of your body. In Parkinsons, there are reduced levels of dopamine. For this reason the most obvious changes related to Parkinsons are normally those that affect your movement, including walking, falling, and freezing.

In particular, slowed movement, stiff muscles and changes to posture affect all people living with Parkinsons. These issues and others can lead to challenges with walking, freezing and falling.

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What Are The Causes And Symptoms Of Parkinsons Disease

As a neurodegenerative disorder, Parkinsons Disease leads to the progressive deterioration of motor function due to loss of dopamine-producing brain cells. While the cause of Parkinsons Disease is unknown, researchers speculate that both genetic and environmental factors are involved. Studies also show that men are 50% more likely to develop the disorder than women.

Primary symptoms of Parkinsons Disease:

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Impact Of Falls And Parkinson’s Disease

This 8-minute video alternates between an interview with a man sharing his experience of falling due to Parkinson’s disease, with a doctor, physical therapist and occupational therapist explaining why people with PD fall, the benefit of physical therapy and exercise before a person has ever fallen to prevent falls and what an occupational therapist can do to prevent falling at home and in the broader environment.

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Conditions That Mimic Shuffling Gait Seen In Parkinsons:

Please read the article on shuffling gait. It describes 5 causes of shuffling of gait.

The most crucial mimic to remember is Normal Pressure Hydrocephalus .

The person with NPH feels like he is stuck to the ground. This is a magnetic gait. It is easy to mistake this for Parkinsons disease.

For example, see this video posted by the Hydrocephalus Association of America on youtube:

NPH can be treated by implanting a small shunt pipe. This shunt drains excess water around the brain into the abdomen.

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Support For People Living With Parkinsons Disease

Impact of Falls and Parkinson’s Disease

While the progression of Parkinsons is usually slow, eventually a persons daily routines may be affected. Activities such as working, taking care of a home, and participating in social activities with friends may become challenging. Experiencing these changes can be difficult, but support groups can help people cope. These groups can provide information, advice, and connections to resources for those living with Parkinsons disease, their families, and caregivers. The organizations listed below can help people find local support groups and other resources in their communities.

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What Are The Important Points Regarding Duodopa At The End Of Life

Duodopa is a continuous infusion of dopaminergic medication administered as a gel into the gut, pumped via a percutaneously inserted gastrostomy tube . There is a requirement for care of the stoma and PEG tube together with functioning of the pump by the patient or carer.41 It reduces the time in motor off periods in advanced PD and quality of life.42 There is evidence of effective treatment up until death from within a case series.43

What Causes The Condition

First described in 1917 by James Parkinson as the shaking palsy, PD is characterized by a loss of neurons in the substantia nigra portion of the brain. A buildup of the protein alpha-synuclein causes dopamine producing cells to fail and die. There is no known specific cause of PD but it is considered to be a combination of genetic and environmental factors just like PSP.

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The Parkinsons Disease News Today Forums Are A Place To Connect With Other Patients Share Tips And Talk About The Latest Research Check Them Out Today

To test this, the researchers assessed 179 people with Parkinsons who were seen at the National Institute of Neurology and Neurosurgery in Mexico City. The participants clinical history, including fall history in the past year, was taken.

Participants underwent a series of evaluations, including disease state using the Hoehn and Yahr scale, assessment of motor symptoms using relevant parts of the Movement Disorders Society Unified Parkinsons Disease Rating Scale, as well as non-motor symptoms using the Non-Motor Symptoms Scale.

Overall, 16.8% had experienced a fall in the last year, with just over half of these having experienced more than one fall the average was 2.5 falls per month. The researchers noted that this is a very low proportion of patients who experienced falls , which could partially be explained by under-representation of advanced forms of the disease, a limitation of the study.

The researchers constructed statistical models using several types of data that they had collected, with the aim of identifying factors that were significantly over-represented among the fallers thus, being predictive of falling.

They found that the severity of motor and non-motor symptoms in the participants was not significantly linked with fall risk.

While about half of the people in the non-fall group had the PIDG subtype, nearly all of those in the fall group had the subtype.

Dealing With Overlap Of Primary Studies

Risk of Falls in Parkinsons Disease: A Cross

Overlap of primary studies within included systematic reviews is a challenge exclusive to umbrella reviews. Currently, there is a lack of guidance on how best to manage this occurrence . To maximise comprehensiveness of this umbrella review, we employed a full inclusion scenario where all Cochrane reviews and non-Cochrane reviews were included . A list of the primary studies included in each systematic review was assembled and a matrix of evidence table was created to determine the amount of overlap between systematic reviews. To avoid double-counting outcome data the following were decided:

  • Any systematic review that contained a relevant primary study that was not in any other systematic review was included so that data were not lost.

  • Any systematic review that did not contain any unique primary study was excluded to minimise duplication of data.

  • In the presence of complete overlap between reviews, the highest quality review, as determined by the A MeaSurement Tool to Assess Systematic Reviews 2 was included in data synthesis and analysis.

  • In cases where there was a complete overlap between reviews and they received the same AMSTAR 2 rating, then the most recently published review was included.

  • In the presence of partial overlap, all reviews were included but the degree of overlap was noted and its implications on the findings of this umbrella review were discussed.

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What Does Kill People With Parkinsons

While no one dies directly from Parkinsons, you may be asking yourself what does typically cause death in Parkinsons patients. The two of the biggest causes of death for people with Parkinsons are Falls and Pneumonia:

Falls Parkinsons patients are typically at an increased risk of falls due to postural instability and other symptoms of Parkinsons. This poses a great risk to those with PD because falls are the leading cause of injury-related deaths among those 65 years or older according to the CDC. It is important to take precautions to limit the risk of falling in your home. This can be done by wearing special grip socks to prevent slipping or installing handrails in high-risk areas like the shower or staircase. In addition, you should talk with your doctor about getting a physical therapy evaluation periodically to strengthen your balance reflexes and help you develop other strategies to keep you safe in the home.

Palliative Care As An Option

If your loved one is not eligible for hospice, the good news is that they can still receive palliative care. This type of care focuses on alleviating symptoms, discomfort, and stress associated with any illness, including PD.

The main difference between palliative care and hospice is that palliative care can be given along with standard treatments, including therapies intended to prolong life.

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Falls And Common Household Hazards

If you or a loved one has Parkinson’s disease, here are tips for preventing falls around the home:

  • Floors. Remove all loose wires, cords, and throw rugs. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its accustomed place.
  • Bathroom. Install grab bars and nonskid tape in the tub or shower. Use nonskid bath mats on the floor or install wall-to-wall carpeting.
  • Lighting. Make sure halls, stairways, and entrances are well lit. Install a night light in your bathroom or hallway. Make sure there is a light switch at the top and bottom of the staircase. Turn lights on if you get up in the middle of the night. Make sure lamps or light switches are within reach of the bed if you have to get up during the night.
  • Kitchen. Install nonskid rubber mats near the sink and stove. Clean up spills immediately.
  • Stairs. Make sure treads, rails, and rugs are secure. Install a rail on both sides of the stairs. If stairs are a threat, it may be helpful to arrange most of your activities on the lower level to reduce the number of times stairs must be climbed.
  • Entrances and doorways. Install metal handles on the walls adjacent to doorknobs of all doors to make it more secure as you travel through the doorway.

Data Synthesis And Analysis

Home Safety Modifications for Parkinson’s Disease

Given the heterogeneity in populations, outcomes and analyses, the findings of included reviews were primarily summarised using a narrative synthesis with the quantitative tabulation of results as appropriate. The primary analyses for this umbrella review were centred on type of neurological condition and type of intervention. Following this, cross-comparison of similarities and differences in the effect of different interventions between the three conditions were reported and discussed. The outcomes of each included systematic review were considered and discussed in the context of their methodological quality, as determined by the AMSTAR 2 and the GRADE algorithm.

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Comparison Between Fallers And Nonfallers

Fallers were older and had longer disease duration and increased disease severity according to the UPDRS , Hoehn and Yahr and Schwab and England activities of daily living scores. In addition, fallers scored worse in the Mini-Mental State Examination and experienced a higher frequency of motor fluctuations, dyskinesia, and freezing of gait . Tremor as the initial predominant symptom was more frequent in nonfallers. Fallers were treated with higher doses of levodopa and more frequently received COMT inhibitors, central cholinesterase inhibitors, and atypical neuroleptics than nonfallers . Patients treated with central cholinesterase inhibitors had dementia associated with PD and those treated with quetiapine had hallucinations.

Further Testing In Parkinsons

In other situations, where perhaps the diagnosis is not as clear, younger individuals are affected, or there are atypical symptoms such as tremor affecting both hands or perhaps no tremor at all, further testing may help. For example, imaging can play a role in differentiating between essential tremor and Parkinsons. It can also be important to confirm what is initially a clinical diagnosis of Parkinsons prior to an invasive treatment procedure such as surgical DBS

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Get Daily Living Aids That Can Help You Stay Independent And Safe

Among the tools that an occupational therapist might recommend are railings around your toilet and bathtub, a seat to use in the tub or shower, a pump soap dispenser instead of bar soap, an electric toothbrush and razor, a cordless phone that you can carry around with you, nonskid socks and Velcro-closure shoes, and an appropriate cane, walker, rollator or wheelchair to help you move around effectively.

Five Fall Prevention Strategies For People With Parkinsons Disease

Parkinson

Balance, posture and gait issues, vision changes and orthostatic hypotension increase your risk of falling. This blog post recommends talking with your neurologist to determine your risk for falling and making changes to reduce that risk, like medication adjustments, assistive devices, exercises that focus on balance and small adjustments in your home.

This webpage has tips for home safety throughout the house.

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Fatal Falls In Older Adults Are On The Rise

The title of this article is a little overly dramatic, although the CDC did report just that, and falls are the leading cause of injury in Americans over age 65. This article provides the stats as well as listing factors that increase fall risks for seniors, and strategies you can employ to prevent falling,

Shortcomings Of This Study

The authors recognise that there are shortcomings of this study.

It may be argued that subjects should have been assessed a certain time after taking their antiparkinsonian medication. This could not happen, largely for logistical reasons such as patient transportation and the need for patients to be assessed by a variety of professionals.

No controls were used. This was because the study was designed to be descriptive and to compare the differences between fallers and non-fallers with PD, rather than the healthy elderly population.

Despite the methods used for prospective assessment, some falls are still likely to have been missed. The high incidence of falls quoted is likely to be an underestimate of the number of falls that occurred. Perhaps only highly sophisticated long term mechanical monitoring methods would be able to give the true incidence, but these would be impractical.

The confidence intervals in the logistic regression model are wide probably due to the small numbers of subjects. All patients who were available to the authors were recruited, however, so this was unavoidable. Multicentre studies or perhaps meta-analysis would perhaps fully address these issues.

It should also be noted that 32 potential subjects did not participate. These patients were older with more severe disease of longer duration. If they had been included, the incidence of falls may have been even higher.

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What You Can Do

As of 2021, there is no definite cure for Parkinsons disease. There is also no definite known cause. Its likely due to a combination of an individuals susceptibility and environmental factors. Most cases of Parkinsons disease happen without a genetic link.

According to research published in 2012, only report having a family member with the disease. Many toxins are suspected and have been studied, but no single substance can be reliably linked to Parkinsons.

However, research is ongoing. Its estimated that

Person Delivering The Intervention And Intervention Setting

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The person delivering the intervention and intervention setting were not regularly reported in included systematic reviews. Of those presenting the person delivering the intervention, physiotherapists were most common, other disciplines included occupational therapists, yoga instructors, Tai Chi instructors, optometrists and multi-disciplinary teams. Interventions were primarily delivered in the community or the participants homes, but other settings including rehabilitation centres, hospitals and acute care were also reported.

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