Risk of Falls and Need of Walking Aid in Parkinson's Disease: Incidence and Impact of Comorbidities.
Falls and the need for walking aids are common in Parkinson's disease, with modifiable risk factors providing potential targets for intervention.
Where it sits
this study against the rest of the tesofensine corpusSummary and findings
The study investigated the incidence of falls and the need for walking aids in 415 Parkinson's disease patients over a 10-year period. It identified cognitive decline, freezing, and comorbidities like diabetes and depression as risk factors for falls. Older age and lower walking speed were associated with increased walking aid use.
Abstract
<h4>Background</h4>Predicting falls in patients with Parkinson's disease (PD) is challenging despite their significant frequency and consequences.<h4>Objectives</h4>To determine incidences of first fall, walking aid requirement, and identify risk factors of subsequent risk, including factors unrelated to PD.<h4>Methods</h4>Study in 415 PD patients (DIGPD prospective cohort). Cumulative incidence curves were calculated and Generalized Linear Mixed Models investigated influencing factors.<h4>Results</h4>Five years after diagnosis, 26.1% of patients experienced falls while only 2.1% required walking aids; after 10 years, it rose to 66.5% and 17%, respectively. Median time to first fall was 7.9 years. Risk factors of falls were cognitive decline, freezing, comorbidities such as diabetes and depression, history of falls particularly in male, or low Body Mass Index (BMIs). Walking aids risk factors were older age, freezing, lower walking speed, higher BMIs, history of walking aid.<h4>Conclusions</h4>Treatable comorbidities (depression, diabetes, weight regulation) should be addressed in daily care to avoid falls in PD patients.
Background
Falls are a common and serious issue for patients with Parkinson's disease (PD), often leading to significant morbidity. Predicting and preventing falls in this population is challenging due to the complex interplay of disease-related and unrelated factors. This study aims to quantify the incidence of falls and walking aid use in PD patients and to identify modifiable risk factors, which could inform clinical management strategies.
Methods
The study was conducted using a prospective cohort design involving 415 patients with Parkinson's disease from the DIGPD cohort. Cumulative incidence curves were used to determine the incidence of falls and walking aid use over time. Generalized Linear Mixed Models were employed to identify risk factors influencing these outcomes. The primary outcomes were the incidence of first falls and the requirement for walking aids over a 10-year period.
Results
Five years post-diagnosis, 26.1% of patients experienced falls, and 2.1% required walking aids. By 10 years, these figures increased to 66.5% and 17%, respectively. The median time to the first fall was 7.9 years. Risk factors for falls included cognitive decline, freezing, comorbidities such as diabetes and depression, a history of falls, male gender, and low BMI. Risk factors for requiring walking aids included older age, freezing, lower walking speed, higher BMI, and a history of walking aid use.
Interpretation
The study highlights that a significant proportion of PD patients experience falls and require walking aids over time. The identified risk factors, many of which are modifiable, suggest potential targets for intervention to reduce fall risk. However, the observational nature of the study limits causal inference, and the findings may not be generalizable beyond the studied cohort. The clinical significance of these findings lies in the potential for targeted management of comorbidities to mitigate fall risk.
Key findings
- 26.1% of patients experienced falls 5 years after diagnosis.
- 2.1% required walking aids 5 years after diagnosis.
- 66.5% experienced falls 10 years after diagnosis.
- 17% required walking aids 10 years after diagnosis.
- Median time to first fall was 7.9 years.
Limitations
- observational study design
- specific to DIGPD cohort
- potential for unmeasured confounding
- findings may not generalize to all PD populations