Near-falls in people with Parkinson's disease: Circumstances, contributing factors and association with falling

• Published in: Clinical neurology and neurosurgery 2017-10, Vol.161, p.51-55
• Main Authors: Gazibara, Tatjana, Kisic Tepavcevic, Darija, Svetel, Marina, Tomic, Aleksandra, Stankovic, Iva, Kostic, Vladimir S., Pekmezovic, Tatjana
• Format: Article
• Language: English
• Subjects: Accidental Falls; Aged; Balance; Cognitive ability; Disability; Falls; Female; Follow-up; Follow-Up Studies; Gait; Gait Disorders, Neurologic - etiology; Gait Disorders, Neurologic - physiopathology; Humans; Male; Middle Aged; Mortality; Movement disorders; Near-falls; Neurodegenerative diseases; Neurology; Parkinson Disease - complications; Parkinson Disease - physiopathology; Parkinson's disease; Postural Balance - physiology; Risk Factors; Tripping/postural instability
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2017.08.008

•Tripping was the most common cause of near-falls in fallers, while postural instability was the most common in non-fallers.•After adjustment, severe freezing of gait was associated with sustaining episodes of near-falls over 1year of follow-up.•After adjustment, near-falls in the first 6 months were not associated with falling in the latter 6 months of follow-up. To describe circumstances of near-falls among persons with Parkinson's disease (PD), assess factors associated with near-falling and assess whether near-falls in the first 6 months are associated with falling in the latter 6 months over one year of follow-up. In the period August 2011-December 2012, 120 consecutive persons with PD, who denied having fallen in the past 6 months, were recruited at Clinical center of Serbia in Belgrade. Occurrence of falling and near-falls was followed for one year. A total of 31 persons with PD (25.8%) experienced near-falls, but did not fall. Of 42 fallers, 32 (76.2%) experienced near-falls. Tripping was the most common cause of near-falls among fallers, whereas postural instability was the most common in non-fallers. Regardless of falling experience, the most common manner to avoid fall was holding onto furniture or wall. After adjustment for multiple motor and non-motor PD features, more severe freezing of gait was associated with occurrence of near-falls over one year of follow-up (odds ratio [OR]=1.08, 95% confidence interval [CI] 1.01–1.16; p=0.043). Adjusted regression analysis did not show associations between near-falling in the first 6 months and falling in the latter 6 months of follow-up. Near-falls commonly occur in persons with PD. More severe freezing of gait appears to predispose near-falling. Fall prevention programs focusing on balance maintenance when experiencing freezing of gait could potentially be useful in reduction of near-falls.