Fall circumstances in the home environment in people with Parkinson’s disease: An exploration of walking aid users.
Abstract
INTRODUCTION
In the recent falls guidelines, multidomain interventions are recommended for people with Parkinson’s disease (PwP) [PMID:36178003]. Walking aids improve local balance and stability, increase confidence and reduce mechanical effort associated with walking [PMID:20674533], however walking aid use is associated with recurrent falls in PwP [PMID:25095816]. This study aimed to understand pre-fall activity and environmental fall risk in fallers and the differences associated with walking aid use.
METHODS
An online survey was developed to evaluate retrospective falls in adults ≥60y. 117 PwP responded to the survey. The survey covered basic descriptors, walking aid use, fall history (2y) and contextual information about falls.
RESULTS
48 PwPD used a walking aid and of those 43 (90%) had fallen (PDfaller+AID). 69 PwP did not use a walking aid and of those 36 (52%) had fallen (PDfaller-AID). Results are reported for PDfaller+AID and PDfaller-AID. The groups were similar in age and sex. Fear of falling (Short FES-I) was significantly higher in PDfaller+AID (p<0.001).
For PDfaller+AID, the top three pre-fall activities were: turning (72%); walking (63%); and moving too quickly (51%). For PDfaller-AID, the top three pre-fall activities were: turning (67%); moving too quickly (42%); and bending down (31%). For both groups, the top three home environmental risk factors were: objects on the floor; slope/uneven surface; and steps/stairs.
77% of PDfaller+AID were not using their walking aid at the time of the fall. Of these respondents tripping over the door trim/ threshold was most common compared to those who were using their walking aid at the time of the fall who fell on the steps/stairs.
CONCLUSION
Holistic approaches targeting gait and balance in combination with home modifications are required. Despite being prescribed a walking aid, the majority of PDfaller+AID were not using it at the time of the fall. Barriers to using walking aids in the home environment that should be explored.
[1] Montero-Odasso 2022 PMID:36178003 [2] Cetin 2010 PMID:20674533 [3] Canning 2014 PMID:25095816
Comments
Interesting research
If I understand correctly, according to your survey, more fallers used a walking aid than those who didn't. What did you conclude from this statistic? Shouldn't it be the other way round?
Thank you for your comment!…
Thank you for your comment! You have understood correctly - the sample of respondents completing the survey had a slightly higher number of fallers using a walking aid compared to the number of fallers who do not use a walking aid (n=43 vs. n=36). You are correct that we may have expected this to be the other way round - despite this; a similar number of respondents in 3 of the 4 groups is encouraging as it suggests that we were able to canvas the responses of a diverse sample including individuals who were relatively unimpaired (non-fallers not using a walking aid) and a range of fallers including those who were independently ambulant vs. walking aid users. We had a relatively small number of non-fallers using a walking aid which was to be expected.
Important topic in PD!
How did you determine which circumstances of falls to measure?
Thank you!
The survey was initially designed to focus on environmental risk factors within the home - in addition to this; we also asked about pre-fall activity and walking aid use which enabled the secondary sub-analysis in the poster.