Slow Down and Concentrate: Time for a Paradigm Shift in Fall Prevention among People with Parkinson’s Disease?

Introduction. We know little about how environmental challenges beyond home exacerbate difficulty moving, leading to falls among people with Parkinson’s (PwP). Aims. To survey falls beyond home, identifying challenges amenable to behaviour change. Methods. We distributed 380 questionnaires to PwP in Southern England, asking participants to count and describe falls beyond home in the previous 12 months. Results. Among 255 responses, 136？PwP (diagnosed a median 8 years) reported falling beyond home. They described 249 falls in detail, commonly falling forward after tripping in streets. Single fallers (one fall in 12 months) commonly missed their footing, walking, or changing position and recovered to standing alone or with unfamiliar help. Repeat fallers (median falls, two) commonly felt shaken or embarrassed and sought medical advice. Very frequent fallers (falling at least monthly; median falls beyond home, six) commonly fell backward, in shops and after collapse but often recovered to standing alone. Conclusion. Even independently active PwP who do not fall at home may fall beyond home, often after tripping. Falling beyond home may result in psychological and/or physical trauma (embarrassment if observed by strangers and/or injury if falling backwards onto a hard surface). Prevention requires vigilance and preparedness: slowing down and concentrating on a single task might effectively prevent falling. 1. Introduction Postural instability is common in Parkinson’s disease (PD): falls are likely to be a frequent problem for most people with Parkinson’s (PwP) by 10 years after diagnosis [1]. Approximately one third of elderly people falls in any given year but approximately two thirds of PwP [2]. Most falls among PwP happen at home; for example, 80% of the 639 fall recorded over six months in one fall-prevention trial [3]. Current opinion about preventing falls in PD favours a multimodal approach: a combination of exercise and developing new movement strategies, coupled with optimal medical management [4]. PwP use attentional mechanisms and other cues to compensate for movement difficulty [5–7]: it is possible that they would find a distracting environment more challenging than one in which they could preserve focus. Small, qualitative studies have explored this possibility in relationship to walking, though not falls. As Lamont et al. wrote, after discussing community walking in focus groups with 18 PwP, “Challenging environments that demand attention may compromise the ability to walk” [8]. Jones et al. concluded from 20 semistructured interviews that