FREQUENCY AND RISK OF FALLS IN PARKISON’S DISEASE PATIENTS IN IBADAN
Background: Falls are a common and devastating occurrence in Parkinson’s disease (PD). Studies
had shown that there is increasing incidence of falls among patients with PD compared to those of
community dwelling healthy adults. Falls in these patients have been associated with poor quality
of life as some patients may suffer bone fractures. Assessing risk factors and frequency of falls in
PD patients had been done in the United Kingdom and other developed countries using National
Institute for Clinical Excellence (NICE) guidelines, to advocate as well as lobby policy makers to
showcase burden and appropriate intervention and prioritization. So far there’s dearth of
information on falls in PD patients in Nigeria and sub- Saharan Africa despite a significant
population of PD in the country. The frequency and risk of falls and their attending complications
in PD patients were therefore studied.
AIM: To determine the frequency and risk of falls in PD patients compared with age matched
controls in Ibadan
Method: The study was an observational study with case control design and ethical clearance was
obtained from Ethical and Research Committee of the University of Ibadan/University College
Hospital, Ibadan. A total of 162 participants consisting of 81 PD patients and 81 age- matched,
apparently healthy control adults were studied. Diagnosed PD patients were assessed for risk
factors and frequency of falls using the following: Tinetti gait and balance test, Hoehn and Yahr
severity scale, Time up and Go, Community Screening interview for Dementia (CSI’D), Unified
Parkinson’s disease rating scale (UPDRS), Geriatric depression scale (GDS) and quality of life
scale, short form Parkinson’s disease questionnaire (PDQ-8). Descriptive, univariate and
multivariate analysis were performed at 95% confidence level. Data was analyzed using SPSS
software version 22.
Result: The mean age of PD group was 65.6 (SD=9.7) years, while that of control was 64.8 (SD
=10.8) years with no statistical difference between the two means (p = 0.631 ).
Analysis of the risk factors that were significantly associated with falls included: disease duration
(p= <0.001), severity of PD (p= <0.001) measured by the following scales (MHY, UPDRS sub
section 1, Motor examination UPDRS sub-section 111), postural instability (p = 0.004) measured
by Tinetti gait and balance scale and Time UP and GO, cognitive dysfunction (p= 0.008) measured
by CSI’D and orthostatic hypertension (p=0.007) measured by sphygmomanometer.
There was significantly higher proportion of falls among the PD participants (Thirty-four (42%)
compared to twelve (14.8%) controls (p= <0.001).Twenty-three (67.6%) of the PD patients that
fell sustained injury. Twenty-three (67.7%) of the PD group had recurrent falls. Thirty-one (44.9%)
admitted to fear of falling among the PD group compared to twelve (15.6%) in control group.
Disease duration (p=<0.001), fear of falling (p= <0.001), cognitive impairment (p=0.034) and
orthostatic hypotension (p=0.007) were significantly associated with increased risk of falls in
univariate analysis. However they could not independently predict fall except disease severity
measured by UPDRS (X2: 35.2, p=0.019) following logistic regression.
Conclusion: This study showed that there was an increased frequency of falls in PD patients when
compared to healthy adult population with similar demographics. The risk factors identified using
simple validated tools were disease severity, disease duration, previous falls, fear of falling,
postural instability, cognitive impairment and orthostatic hypotension.