Objectives: To accurately establish the incidence of falls in Parkinson's disease (PD) and to investigate predictive risk factors for fallers from baseline data. Methods: 109 subjects with idiopathic PD diagnosed according to the brain bank criteria underwent a multidisciplinary baseline assessment comprising demographic and historical data, disease specific rating scales, physiotherapy assessment, tests of visual, cardiovascular and autonomic function, and bone densitometry. Patients were then prospectively followed up for one year using weekly prepaid postcards along with telephone follow up. Results: Falls occurred in 68.3% of the subjects. Previous falls, disease duration, dementia, and loss of arm swing were independent predictors of falling. There were also significant associations between disease severity, balance impairment, depression, and falling. Conclusions: Falls are a common problem in PD and some of the major risk factors are potentially modifiable. There is a need for future studies to look at interventions to prevent falls in PD.

Recurrent falls are a disabling feature of Parkinson's disease (PD). We have estimated the incidence of falling over a prospective 3 month follow-up from a large sample size, identified predictors for falling for PD patients repeated this analysis for patients without prior falls, and examined the risk of falling with increasing disease severity. We pooled six prospective studies of falling in PD (n = 473), and examined the predictive power of variables that were common to most studies. The 3-month fall rate was 46% (95% confidence interval: 38-54%). Interestingly, even among subjects without prior falls, this fall rate was 21% (12-35%). The best predictor of falling was two or more falls in the previous year (sensitivity 68%; specificity 81%). The risk of falling rose as UPDRS increased, to about a 60% chance of falling for UPDRS values 25 to 35, but remained at this level thereafter with a tendency to taper off towards later disease stages. These results confirm the high frequency of falling in PD, as almost 50% of patients fell during a short period of only 3 months. The strongest predictor of falling was prior falls in the preceding year, but even subjects without any prior falls had a considerable risk of sustaining future falls. Disease severity was not a good predictor of falls, possibly due to the complex U-shaped relation with falls. Early identification of the very first fall therefore remains difficult, and new prediction methods must be developed.

No abstract

No abstract

No abstract

There are few studies of osteoporosis in Parkinson's disease (PD). We assessed the prevalence of osteoporosis in a PD clinic cohort. All subjects with a confirmed diagnosis of PD attending a clinic were invited to participate. All consenting subjects had bone density measured by dual energy X-ray absorptiometry scanning. Further data, including demography, disease duration, and disease severity, were collected. One hundred five subjects participated; median age was 75 (54-92) years. Fifty-one (49%) patients were men. Of the men: median T score, -1.3 (range, -4.7 to 3.8); median Z score, 0.0 (-3.2 to 4.7); diagnostic categories: osteoporosis, 20%; osteopenia, 41%; normal, 39%. Of the women: median T score -2.7 (-4.7 to 1.4); median Z score, -0.25 (-2.6 to 4.2); diagnostic categories: osteoporosis, 63%; osteopenia, 28%; and normal, 9%. Whole sample: osteoporosis, 42%; osteopenia, 34%; and normal, 24%. There were associations between age, depression, disease duration, and osteoporosis but not with disease severity. Female gender was an independent predictor of osteoporosis. The prevalence of osteoporosis/osteopenia is considerable in PD patients but does not exceed that of other people of similar age. Osteoporosis/osteopenia was present in almost all women of this age group with PD.

For those dying in hospital, there are few previously documented end-of-life care discussions with patients or their relatives. The use of end-of-life pathways and access to specialist palliative care is variable. Following the Neuberger report, the Liverpool Care Pathway is to be replaced with individual end-of-life care plans. It is important to engage patients, and their relatives, in decision making regarding preferences at the end of life.

Hospital attendances and admissions were relatively common, even after institutional care home placement. Events precipitating admission, such as falls, might be preventable. PD nurse specialists could be an effective way to help train staff in homes where someone is known to have PD.