title: [Falling in Parkinson disease: more often due to postural instability than to environmental factors].
abstract: OBJECTIVE
  To document the circumstances surrounding falls in patients with Parkinson's disease.
  
  
  METHODS
  Prospective.
  
  
  METHODS
  Parkinson patients with a check-up appointment in the period 1 May 1998-31 May 1999 at the Neurology Outpatient's Department of Leiden University Hospital, used standardized forms to record the circumstances surrounding all incidents of falling during the subsequent 6 months. For control purposes, a partner or acquaintance with comparable living conditions was asked to do the same. The researchers judged whether falls were related to physical impairment (personal, intrinsic factors) or environmental factors (extrinsic factors).
  
  
  RESULTS
  59 patients with Parkinson's disease (21 women (36%); mean age: 60.8 years; mean Hoehn and Yahr score: 2.3) and 55 controls (37 women (67%); mean age: 59.6 years) were studied. Patients reported 205 falls and controls 10 falls. Recurrent (> or = 2) falls occurred in 15 patients (25%) and two controls (4%) (relative risk (RR): 9.0: 95% confidence interval (95% CI): 2.0-41.7). Recurrent falls were more common among persons using benzodiazepines (RR: 5.0: 95% CI: 1.6-15.5). Reliable information was obtained for 160 falls in patients. Most falls (79%) had an intrinsic cause, like turning around, standing up, bending and stumbling. Abrupt movements were a particularly frequent cause of falls. Simultaneous performance of multiple tasks contributed to almost 50% of falls in patients.
  
  
  CONCLUSIONS
  Falls are common among Parkinson patients. Most falls are related to intrinsic factors. Prevention of these intrinsic falls requires treatment of the underlying postural instability. Use of benzodiazepines must be avoided whenever possible. Interventions aimed at extrinsic factors, such as reduction of domestic hazards, are possibly less effective.
authors.affiliation: Leids Universitair Medisch Centrum, afd. Neurologie, Leiden.
authors.forename: M D
authors.initials: MD
authors.lastname: Willemsen
authors.forename: Y A
authors.initials: YA
authors.lastname: Grimbergen
authors.forename: M
authors.initials: M
authors.lastname: Slabbekoorn
authors.forename: B R
authors.initials: BR
authors.lastname: Bloem
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000368:Aged; D014151:Anti-Anxiety Agents / Q000009:adverse effects*; D001569:Benzodiazepines; D016022:Case-Control Studies; D000075202:Contraindications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D004856:Postural Balance / Q000187:drug effects*; D011187:Posture; D011446:Prospective Studies; D012111:Residence Characteristics; D012306:Risk; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D014151:Anti-Anxiety Agents; D001569:Benzodiazepines