Strategies To Reduce Fall Risk In Advanced Parkinson’s

How Parkinson’s Impacts Balance and Increases Fall Risk How Parkinson’s Increases Risk Parkinson’s disease changes your brain, including the parts that control your movement. And as you progress into advanced Parkinson’s , falls become the biggest reason for injury.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d0ec942e-4f4a-4a73-b278-c8d4e970d790 Advanced Parkinson’s can cause these symptoms that affect how well you move:e60dc2a1-f33c-4a05-9b50-8e3e8e597629d0ec942e-4f4a-4a73-b278-c8d4e970d790e60dc2a1-f33c-4a05-9b50-8e3e8e597629d6d1e679-936d-417d-b510-77b243da0fea Poor Balance The result of changes in your strength, posture, reflexes, and how you move Freezing of Gait When your feet feel suddenly stuck to the floor Thinking Changes Trouble with focus and multitasking Festination Shuffling, small, quick steps that increase the risk of tripping Orthostatic Hypotension A sudden drop in blood pressure when you move from a sitting or lying to a standing position Sensory Signals Inability to tell how your feet are positioned or notice an angled floor Vision Problems Blurriness, seeing double, and less ability to estimate distance Medications can also increase your risk of falls, especially when you take narcotics, some seizure medications, or many meds at once.e60dc2a1-f33c-4a05-9b50-8e3e8e59762998462b66-9724-4cc5-8db9-9c6e978c2daf Parkinson’s disease medications can also cause side effects like drowsiness and confusion, which increase fall risk.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d6d1e679-936d-417d-b510-77b243da0fea People with advanced Parkinson's lose their ability to move automatically, so controlling how each foot moves while walking requires more focus and conscious effort, says James Liao, MD , a neurologist at Cleveland Clinic Neurological Institute in Ohio. Because of this change, anything that disturbs someone's focus while walking can make them unsteady, says Dr. Liao. Advanced Parkinson’s disease can make balance and movement more difficult, which creates a higher risk of falls.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297ebedb7c-cdef-4bdc-b957-0244c3a5c6c8 Falling with this movement disorder is common, and one large study review found that about 1 out of every 2 people with Parkinson’s falls at least once.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295d09737a-809f-411e-ab47-16a3f033bae9 Falls can cause head injuries and break bones, so it’s important to prevent them when possible.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297ebedb7c-cdef-4bdc-b957-0244c3a5c6c8 “With Parkinson’s, understanding your personal [fall] risk factors and taking proactive steps can make a meaningful difference,” says Ejaz Shamim, MD , a neurologist at Kaiser Permanente in Maryland. “Falls are one of the leading causes of loss of independence as we age, but they are not inevitable.” Below, learn what boosts Parkinson’s disease fall risk and what you can do to lower yours. Overcoming the Fear of Falling Overcoming Fear of Falling If you worry about falling, you’re not alone.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298d675267-1249-49d6-b93c-5a0878ead923 But fear of falling can lower your quality of life and make you less independent.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291234b0bd-0e3a-4398-b708-c23b5da9771d If you don’t keep your body moving, your muscles and bones can get weak, increasing your risk of both falling and fractures if you do take a spill.e60dc2a1-f33c-4a05-9b50-8e3e8e59762965f23fa7-b343-4fe3-8432-053d608836bd To process this fear and get the physical activity you need, start by following the steps above. One study found pushing through the fear of falling and “doing it afraid” increased quality of life. But that may not be a good option for everyone. You can also lean on support from family, friends, and mental health professionals.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298d675267-1249-49d6-b93c-5a0878ead923 “If you have fallen before or feel unsteady, do not ignore it — talk with your healthcare team,” says Shamim. “Together, we can create a plan that supports mobility, safety, and quality of life.” Talking to Your Doctor About Preventing Falls Preventing Falls Your healthcare provider can help you lower your fall risk by addressing medications and other conditions. “Fall prevention starts with an honest conversation,” says Dr. Shamim, who encourages his patients to bring up side effects, blood pressure issues, freezing episodes, and thinking changes so they can address them together. Liao works with his patients to optimize medications for faster movements, less rigidity, and fewer freezing episodes. But he also looks for other possible risk factors. “There are often specific causes of falls that can be treated,” says Liao, like vision problems, confusion, orthostatic hypotension, neuropathy, joint pain, and spinal stenosis (narrowing). Your provider can check for changes to your hearing and vision, which can both affect balance. They can also make sure you’re getting enough vitamin D and calcium for strong bones, which protect against fractures if you have a fall.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295bf93721-d078-4380-b668-20ccf9a06cf3e60dc2a1-f33c-4a05-9b50-8e3e8e59762969842ad3-cbce-4378-b989-124423e4dc42e60dc2a1-f33c-4a05-9b50-8e3e8e59762961a26768-2319-4b30-9144-0e76c2c635b9 While these nutrients help bones stay strong, you should still check with your provider first before starting any new supplement. Physical Therapy and Movement Strategies Physical Therapy Physical therapy can help you stay safe from falls by teaching you personalized movement strategies, muscle-strengthening exercises, and how to use an assistive device like a walker.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cfe38c96-1e8c-4604-affd-efd2e5a386fc Movement Cues If you get stuck in a freezing episode , cues can get you moving again. Your physical therapist may show you cueing tips like these:e60dc2a1-f33c-4a05-9b50-8e3e8e5976293e500dd4-a845-45fa-8327-c99b7ab6e798 Pick a new move. If you can’t step forward, try stepping to the side or raising your arm instead. Laser-point the way. A red dot on the floor in front of your foot can give your brain a movement goal. Imagine an obstacle. Picture a stick or cane on the ground in front of you and step over it. You have a lot more to choose from, and your therapist can help you try them until you find one that works. For example, you can also try shifting your weight back and forth before taking a step. Or you can hum a song and try to step forward with the beat.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293e500dd4-a845-45fa-8327-c99b7ab6e798 LSVT BIG LSVT-BIG therapy teaches you to use bigger movements to decrease Parkinson’s symptoms. This specialized training can help you move faster and lessen repetitive movements that can increase your fall risk.e60dc2a1-f33c-4a05-9b50-8e3e8e597629153b709c-4f33-488d-a18c-f033add2a9d8 Strengthening Exercises Your physical therapist will also ask you to do exercises designed to target specific muscles. As you get stronger, you can improve your posture, balance, and gait (how you walk).e60dc2a1-f33c-4a05-9b50-8e3e8e597629463fb13d-ff1e-4d4c-948e-7c8c8085a4bd “The earlier you build strength, balance, and safe movement habits, the better,” says Shamim. “If you have not started exercising, the best time to start is now.” Fall Recovery If you fall, you haven’t failed. Your physical therapist can show you how to safely get back up after a fall and how to make your home as safe as possible.e60dc2a1-f33c-4a05-9b50-8e3e8e597629700ffa0f-c4ab-4487-a17d-697af907af1c Assistive Devices “At some point, it becomes unsafe to walk without an assistive device like a cane or walker, so these should be used when the time comes,” says Liao. Our goal is to keep people mobile and physically active for as long as possible, but we want to also prioritize safety, Liao adds.e60dc2a1-f33c-4a05-9b50-8e3e8e597629463fb13d-ff1e-4d4c-948e-7c8c8085a4bd Resources We Trust Mayo Clinic: Fall Prevention: Simple Tips to Prevent Falls Cleveland Clinic: Falling Accidents and Injuries Parkinson's Foundation: Fall Prevention in Parkinson’s Stanford University: Fall Prevention Kaiser Foundation Health Plan: How to Get Up Safely After a Fall: Care Instructions Modifying Your Home for Fewer Fall Risks Modifying Your Home Beyond learning new ways to move with your physical therapist, you can make some changes at home to prevent falls .e60dc2a1-f33c-4a05-9b50-8e3e8e59762944df2c0a-5017-4953-be84-1f1b76fc98ab “Simple home modifications, such as grab bars, handrails, and night lights, are powerful safety tools that reduce risk in high-traffic areas like bathrooms and hallways,” says Shamim. You can also consider these home modification tips:e60dc2a1-f33c-4a05-9b50-8e3e8e59762944df2c0a-5017-4953-be84-1f1b76fc98ab Remove loose rugs and clutter. Place frequently used items within easy reach. Install motion-sensor lights for nighttime bathroom trips. Wear pants that fit well to avoid tripping on the fabric. Think about removing low side or coffee tables. Add color contrast to steps, ramps, or changes in flooring. Use a raised toilet seat with arms you can hold onto. Keep a shower bench in your bathtub or shower. Even in the house, you can wear shoes that help you stay upright. Choose lightweight shoes with a wide base, raised toes, laces, and ankle support. Avoid options with a thick, rubbery sole that can cause tripping.e60dc2a1-f33c-4a05-9b50-8e3e8e59762920009af4-16ca-4f3e-a740-3dd1b2be1252 The Takeaway Parkinson’s disease changes the way you move, and people with this condition have a much higher risk of falling. You can prevent falls in advanced Parkinson's by working with a physical therapist to strengthen your muscles, learn movement cues, and use assistive devices when needed. Smart technology can also offer a way to stay independent and minimize your Parkinson’s disease fall risk. If you aren’t sure where to start, your healthcare provider can help you find the care and assistance you need. Smart Technology and Assistive Devices Smart Technology In this world of smartphones and video calls, you can also take advantage of technology designed for life with Parkinson’s. “ Fall detection systems , including medical alert devices and smart watches, can provide an added layer of safety and peace of mind, especially for people who live alone,” says Shamim. Augmented-reality glasses can provide visual cues that reduce freezing episodes, says Liao. “Wearable devices can track changes in symptoms, warning clinicians and people with Parkinson's when gait is becoming more unstable, and monitoring to see if interventions like medications or therapy are helping.” You could even ask about specialized, laser-guided walkers that project a line in front of you to keep you moving and prevent freezing.e60dc2a1-f33c-4a05-9b50-8e3e8e59762980d0e29a-b8a0-4a77-9bdf-d50d22bf4a1e