Parkinson’s Disease

Review Article

Recurrent Falls in Parkinson’s Disease: A Systematic Review

Table 1

Studies reporting falls prospectively in people with Parkinson’s disease.


First author year	Participant number^a	Inclusion criteria	Exclusion criteria	Fall definition^b	Reporting period	Classification of falls	Number (%) of fallers^c	Number of falls^d	Falls/faller^e	Falls/faller/yr^f	Falls/ participant/ yr^g

Allan 2009 [20]	40 (40)	PD with dementia, >65 years old	Comorbidities affecting ambulation, MMSE ≤ 8, significant visual impairment	2, with or without LOC	12 months	Fall Y/N	36 (90%) ≥ 1 fall	NR	NR	NR	19

Allcock 2009 [15]	164 (176)	Living in the community	NR	2, with or without LOC	12 months	Fall Y/N >1 fall	103 (63%) ≥ 1 fall 32 (20%) = 1 fall 71 (43%) > 1 fall	736 32 704*	7.1* 1.0* 9.9*	7.1* 1.0* 9.9*	4.5* 0.2* 4.3*

Ashburn 2007^‡ and Ashburn 2008^‡ [21, 22]	126 (142)	Independently mobile, living in the community, >1 fall in the last 12 months	Gross cognitive impairment, pain affecting participation, acute medical condition requiring treatment	1, 2, 3	6 months	Fall Y/N >1 fall	95 (75%) ≥ 1 fall 18 (14%) = 1 fall 77 (61%) > 1 fall	639 18 621	6.7 1.0 8.1	13.5 2.0 16.1	10.3 0.3* 10.0

Bloem 2001 [2]	59 (61)	Independently mobile, living in the community, clear response to medication, adequate cognition (MMSE ≥ 24)	Comorbidities affecting balance	1, 2	6 months	Fall Y/N >1 fall	30 (51%) ≥ 1 fall 15 (25%) = 1 fall 15 (25%) > 1 fall	205 15* 190*	6.8* 1.0* 12.7*	13.7* 2.0* 25.3*	6.9* 0.5* 6.4*

Camicioli 2010 [23]	52 (52)	≥65 years old	Dementia, unstable medical illness, other illness affecting thinking or memory	NR	12 months	Fall Y/N >1 fall	21 (40%) ≥ 1 fall 6 (12%) = 1 fall 15 (29%) > 1 fall	76* 6 70*	3.6* 1.0* 4.7*	3.6* 1.0* 4.7*	1.5* 0.1* 1.3*

Chung 2010^‡ [24]	19 (23)	Responsive to levodopa, ≥2 falls or near falls per week, walk independently indoors with or without an aid	Freezing, non-CNS contributors to falls, using cholinesterase inhibitors/ anticholinergic drugs or sedatives, MMSE < 25, any unstable medical condition	1, 2, 3	6 weeks Donezepil 6 weeks placebo	NR	NR NR	104* 199*	NR NR	NR NR	47.3* 91*

Cole 2010 [25]	49 (49)	Nil	Recent/recurrent injury or surgery, unable to ambulate independently with/without a walking aid, significant visual or cognitive impairment (MMSE < 24)	1, 2, 3	12 months	Fall Y/N >1 fall	32 (65%) ≥1 fall 11 (22%) = 1 fall 21(43%) > 1 fall	NR NR NR	NR NR NR	NR NR NR	NR NR NR

Donovan 2011^‡ [26]	23 (32)	Independently mobile but requiring a walking aid, experience FOG	Syncopal episode in prior 6 months, prior exposure to laserlight visual cueing device	1, 2	1 to 2 months baseline 1 month after baseline	Fall Y/N	10 (43%) ≥ 1 fall 10 (43%) ≥ 1 fall	NR	NR	168* 110.2*	73* 47.9*

Fink 2005 [27]	49 (52) men only	≥65 years old, living in the community	Unable to walk independently, bilateral hip replacement	NR	12 months	>1 fall	14 (29%) > 1 fall	NR	NR	NR	NR

Foreman 2011 [28]	36 (36)	>40 years old, independently mobile, gait hypokinesia present, sufficient cognition (MMSE > 23), taking Carbidopa or Levodopa	Had surgical management of PD, uncontrolled motor fluctuations, comorbidities affecting mobility or balance	Person comes to rest on ground	≥6 months	0 or 1 fall >1 fall	22 (61%) > 1 fall	NR	NR	NR	NR

Goodwin 2011^‡ [29]	122 (130) baseline 125 (130) post-baseline	>1 fall in previous year, walk independently indoors with or without a walking aid	Comorbidities affecting ability to exercise safely, unable to follow written or verbal instructions in English	1, 2	10 weeks baseline 20 weeks after baseline	Fall Y/N	109 (84%) ≥ 1 fall 107 (86%) ≥ 1 fall	3453* 5488*	31.7* 51.3*	164.7* 133.4*	138.1* 114.2*

Gray 2000^† [30]	118 (118)	Able to stand and walk a short distance with or without a walking aid	Comorbidities that could predispose to falls, cognitive or writing deficit unless caregiver able to assist completion of falls diary	included “near falls” as a fall	12 weeks	Fall Y/N 1 fall 2 to 3 falls 4 to 5 falls >5 falls	Unclear as near falls included	144	NR	NR	5.3*

Hayashi 2010 [31]	20 (20)	Hoehn and Yahr Stage ≥ 2, responsive to levodopa, receiving regular outpatient treatment every month	Other neurological disease, significant dementia, or autonomic dysfunction	NR	12 months	Fall Y/N >1 fall >5 falls	13 (65%) > 1 fall 6 (30%) > 5 falls	NR NR	NR NR	NR NR	NR NR

Kerr 2010 [16]	101 (106)	Walking independently without aid, living in the community independently	Nil	1, 2, 3	6 months	Fall Y/N >1 fall	48 (48%) ≥ 1 fall 24 (24%) = 1 fall 24 (24%) > 1 fall	NR NR NR	NR NR NR	NR NR NR	NR NR NR

Latt 2009 [13]	113 (113)	Living in the community	Unable to walk without aid, atypical Parkinsonism, insufficient cognition (MMSE < 24)	1, 2	12 months	Fall Y/N	51 (45%) ≥ 1 fall	2160	42.4*	42.4*	19.1*

Lord 2003 [32]	57 (57)	Living in residential elderly care facility	Bedbound	1, 2, 3	6–29 months Followed until death or for at least 6 months Mean = months	Fall Y/N 1 fall 2 to 4 falls 5 falls	36 (63%) ≥ 1 fall 6 (11%) = 1 fall 30 (53%) > 1 fall	NR for PD group alone 6 NR for PD group alone	NR 1.0 NR	NR NR NR	NR NR NR

Mak 2009 [33]	70 (72)	Living in the community, 40–85 years old, medically stable, walk 3 × 6 m with or without a walking aid	Other neurological conditions, communication deficit, impaired cognition (MMSE < 24), postural hypotension, visual disturbance, vestibular dysfunction, other comorbidities limiting locomotion or balance	2, 3	12 months	0 or 1 fall >1 fall	15 (21%) > 1 fall	NR	NR	NR	NR

Mak 2010 [18]	72 (74)	Age ≥ 40 yrs, medically stable, walking independently with or without a walking aid	Other neurological conditions, communication deficit, insufficient cognition (MMSE < 24), visual disturbance, vestibular dysfunction, comorbidities limiting locomotion or balance	2, 3	12 months	1 fall >1 fall	25 (35%) ≥ 1 fall 12 (17%) = 1 fall 13 (18%) > 1 fall	133 12 121*	5.3* 1.0* 9.3*	5.3* 1.0* 9.3*	1.8* 0.2* 1.7*

Matinolli 2011 [34]	125 (125)	Able to stand unsupported	Placed in long-term institutional care	1, 2	24 months	Fall Y/N 1 fall 2–5 falls 6–10 falls 11–100 falls >208 falls	79 (63%) ≥ 1 fall 20 (16%) = 1 fall 59 (47%) > 1 fall	3125 20 3105*	39.6* 1.0* 52.6*	19.8* 0.5* 26.3*	12.5* 0.1* 12.4*

Nilsson 2011^‡ [35]	19 (20)	Idiopathic PD selected for bilateral DBS of the subthalamic nuclei, responsive to levodopa but with insufficient effect, normal brain MRI	Signs of dementia or severe cognitive decline, severe comorbidity, electrode replacement required within 6 months of surgery	1, 2	12 weeks prior to Sx 12 months after Sx	Fall Y/N >1 fall	10 (53%) ≥ 1 fall 5 (26%) = 1 fall 5 (26%) > 1 fall 14 (74%) ≥ 1 fall 2 (11%) = 1 fall 12 (63%) > 1 fall	83 5 78 204 2 202*	8.3* 1.0 15.6* 14.6* 2.0* 16.8*	36.0* 4.3* 67.6* 14.6* 2.0* 16.8*	18.9* 1.1* 17.8* 10.7* 0.1* 10.6*

Smania 2010^‡ [36]	55 (64)	Hoehn and Yahr Stage 3 or 4, able to rise from chair or bed independently, MMSE > 23	Other neurological conditions or conditions that could interfere with the study	1, 2, 3	1 month Baseline 1 month post 1 month follow-up	NR	NR NR NR	1415* 1329* 1337*	NR NR NR	NR NR NR	308.7* 290.0* 291.7*

Wood 2002^‡ [10]	101 (109)	Living in the community	Bedbound, severe medical instability	1, 2, 3	12 months	Fall Y/N >1 fall	69 (68%) ≥ 1 fall 18 (18%) = 1 fall 51 (50%) > 1 fall	585 18 567*	8.5* 1.0* 11.1*	8.5* 1.0* 11.1*	5.8* 0.2* 5.6*

^aParticipant number—number reported (number recruited).
^bFall definition [37]—1 = unintentional/unexpected change in position, 2 = person comes to rest on lower level, 3 = not as a result of a major intrinsic event or overwhelming hazard.
^cNumber (%) of fallers—reported for fallers (single + recurrent), single fallers, and recurrent fallers.
^dNumber of falls—recurrent falls are shown in bold.
^eFalls/faller—number of falls divided by the number of fallers, calculated for each reported fall category.
^fFalls/faller/yr—number of falls divided by the number of fallers, adjusted to give an approximate yearly rate.
^gFalls/participant/yr—number of falls divided by the number of participants in the study, calculated for each reported fall category, and adjusted to give an approximate yearly rate.
Bold font indicates data pertaining to recurrent falls; ^‡study is an intervention trial; *data calculated from published paper; ^†definition of falls included all of the following: “near falls” (i.e., fall initiated but arrested by support from a wall, railing, other person, etc.), “whole body falls,” falls to the hand or knee, and falls that were unable to be categorized based on the information reported by the participant. Only data for “whole body falls” and falls to the hand or knee are reported in this table.
PD: Parkinson’s disease; LOC: loss of consciousness; NR: not reported or insufficient detail to calculate; Y: yes; N: no; FOG: freezing of gait; Sx: surgery.