The motor symptoms, gait disturbances, and postural instability typical of Parkinson’s make falls a common source of injury for people with the disease. As well, many anti-parkinson’s medications contribute to unsteadiness, particularly those that cause drowsiness, dizziness, or orthostatic hypotension (a sudden drop in blood pressure when rising from lying down). Falls are most likely to occur during changes in position from sitting to standing, from standing to walking, when changing direction during movement, and from walking to sitting. Situations in which the person with Parkinson’s is getting in and out of bed, a car, and the shower present high risk for loss of balance and falling.
The person may realize that a fall is imminent but be unable to prevent it or may be unaware of a potential fall until it is under way, too late to prevent it. Because the motor symptoms of Parkinson’s disease impair normal reflexive actions to “break” the fall, such as extending an arm or curling to land with minimal harm to the body, even minor falls can result in injuries such as cuts, bruises, and fractures. Head injuries, even those that appear minor, can have serious consequences, as can falls that take place in the shower or bath. Any head injury that results in loss of consciousness, however brief, requires follow-up, at least by telephone, with the doctor. Family members should know basic first aid including cardiopul-monary resuscitation (CPR).
Measures to reduce the risk of falling are fairly simple. In and around the home,
• Remove throw rugs, including those in the bathroom (and bath mats). Their edges, even when fastened down with carpet tape, tend to catch feet that drag and walking aids such as canes or walkers.
• Arrange furniture so there are clear and wide paths of travel through every room that allow the person with Parkinson’s to walk without concern for bumping into things and comfortably make a U-turn. End tables and coffee tables are often obstacles to sitting in a chair or on a couch.
• Remove or block wheels and casters from chairs, especially those in rooms with hard surface (noncarpeted) floors. Have at least one chair in every room that is sturdy, is steady (does not rock or swivel), has arms, and has a seating surface that is 32 to 36 inches from the floor.
• Run telephone, television cable, electrical cords, and extension cords along baseboards or walls and secure them in place with construction staples such as those staple guns use (straddle the cable or cord with the staple; do not puncture it) or with heavy-duty tape.
• Make sure all interior areas, including hallways and closets, have good lighting. For areas not already wired with fixtures, use battery-operated lights that mount (usually with adhesive patches or small screws) on a wall or ceiling. Choose styles that have easy-to-operate switches; some are turned on and off by pushing the main part of the light.
• Use motion-activated lights in driveways, garages, entry doors, and even basements; there are styles that incorporate the motion sensor into the bulb unit and are screwed into a standard light fixture.
• Install appropriate adaptive equipment and assist devices such as hand railings in bathrooms and hallways, lever-style door handles and light switches, and slip-resistant grips in showers and tubs.
As well, there are precautions the person with Parkinson’s disease can take to reduce the risk of falls further. The most effective is to be aware of fluctuations in motor functions that are related to medication dosages. Falls are most likely to happen when medications are wearing off and motor response is unpredictable. Other precautions include
• When walking, make a conscious effort to lift each foot cleanly off the floor and then place it down again rather than letting it shuffle or drag. Although this activity becomes more difficult as Parkinson’s progresses, such purposeful focus helps to improve balance and mobility.
• Plan for directional changes, and allow enough time and space to conduct them. If it appears the space is too small or constrained, stop to consider the options and then select the one that is safest. Ask for help!
• Turn on the lights before entering a room, even if it is not completely dark. Being able to see clearly helps spatial orientation (judging distance and depth of field) and compensates for postural instability.
• Wear closed, flat-heeled shoes with somewhat smooth soles (not rubberized) and clothing that fits comfortably but is not so loose as to pose a tripping hazard or to be caught on furniture or cabinets.
• Sit down to dress and undress, including when putting on or taking off shirts or blouses. The action of pulling clothing over the head is disorienting and disrupts balance.
When falls do occur, follow a head-to-toe pattern to check for injuries immediately, and then later (such as at bedtime) if the fall seemed substantial. Pain that continues more than 10 or 15 minutes after the fall bears further investigation, if only a telephone call to the doctor. Cuts that gape or do not stop bleeding in a few minutes or injuries that cause the person to resist using an extremity require prompt medical attention. People with Parkinson’s disease often are reluctant to tell family members of falls and other mishaps for fear that doing so will prompt further curtailment of their activities. Low-key reactions in these matters encourage openness about them. It is also a good idea for the caregiver to be observant about fresh bruises, cuts, and other signs of falls.