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Neurological conditions and falls

Any factor that impacts the nervous system is considered a neurological impairment and can impact an older adult’s sensation, balance, coordination, muscle strength, and, ultimately, their ability to stand.

A fall may be the first symptom of an underlying neurological condition.

Some of the common neurological conditions that can increase an older adult’s risk of having a fall include:

Parkinson’s disease

Parkinson’s disease is a movement and mood disorder that occurs when the brain’s nerve cells are not able to produce enough Dopamine, a body chemical essential for movement and the smooth control of muscles. Parkinson’s disease is most often diagnosed around the age of 65 years and over and is a condition that progresses over time.

The risk of falls increases with age much earlier among those with Parkinson’s disease than those without, with one in two people with Parkinson’s disease falling at least once a year.

Falls may also worsen symptoms of Parkinson’s disease, due to falls having the potential to cause a fear of falling, which in turn can affect the way a person moves.

Why does Parkinson’s disease increase falls risk?

There are a number of Parkinson’s disease-related factors that can increase an older adult’s risk of having a fall, including:

  • Physical status: Impaired leg muscle, freezing of gait, poor balance, stiffness, tremors, and slowness of movement (also known as bradykinesia).
  • Cognition: Cognitive failure, depression, and emotional disorders.
  • Medical care: Use of treatment options, such as Levodopa and dopamine agonists.

How can I help older adults with Parkinson’s disease?

A 2022 Cochrane Review of interventions for preventing falls among individuals with Parkinson’s disease found that exercise can reduce the rate of falls by 26% and potentially slightly reduce the number of people experiencing one of more falls by 10%.

Exercise interventions and physical therapy can be helpful in increasing a person with Parkinson’s disease’s motion, confidence, and quality of life, as well as reducing their fear of falling.

Other factors that reduce motion in those with Parkinson’s disease, such as bradykinesia, stiffness, and tremors, can also be treated with medication.

Stroke

A stroke occurs when the blood supply to part of the brain is reduced suddenly, preventing the brain from getting oxygen from the blood.

The level of falls risk among people who have had a stroke can vary largely due to the various levels of individual function and risk that may be present.

It is reported that after a stroke, the incidence of falls can range between 7% in the first week and 73% in the first year after experiencing a stroke.

Why does stroke increase falls risk?

There are a number of stroke-related impairments that can increase an older adult’s risk of having a fall, including:

  • Muscle weakness
  • Gait and balance disturbances
  • Paralysis
  • Sensory loss
  • Reduced attention
  • Depression and cognitive deficits
  • Altered vision
  • Altered spatial awareness.

It is important to remember that a decrease in physical abilities can also increase the likelihood of other falls risk factors, such as reduced physical activity, loss of bone mineral density, and a fear of falling.

How can I help older adults who have had a stroke?

A Cochrane Review of interventions for preventing falls in people after stroke concluded that, other than exercises, there is minimal evidence regarding interventions to reduce falling post-stroke.

The evidence surrounding exercise interventions in people who have had a stroke was found to be beneficial in preventing falls, however not in reducing the number of people who fall. Additionally, no evidence was found regarding falls prevention benefits of strategies such as pre-discharge home visits, replacing multifactorial glasses with single lens distance vision glasses, or a servo-assistive rollator for people who have had a stroke.

There is a current study underway titled the Australian reducing Falls After Stroke Trial (FAST).

Peripheral neuropathy

Peripheral neuropathy occurs when the peripheral nerves in the body are damaged. This causes decreased nerve activity in the extremities, especially the feet, and results in reduced sensitivity.

People with Type 2 diabetes and possible diabetic polyneuropathy are 2.3 times more likely to have a fall than those without peripheral neuropathy.

Why does peripheral neuropathy increase falls risk?

There are a number of peripheral neuropathy-related factors that can increase an older adult’s risk of having a fall, including:

  • Loss of sensation in the body
  • Changes in gait, which can also impact balance
  • Muscle weakness
  • Autonomic neuropathy (damage to the nerves that control internal organs), which can cause postural hypotension
  • Loss of confidence and reduced activity levels
  • Uncontrolled muscle movements
  • Blood pressure changes
  • Bowel and bladder problems

How can I help older adults with peripheral neuropathy?

Research on balance training for older adults with diabetic peripheral neuropathy found value in proprioception training, vestibular training, lower limb strength training, and mixed sports training in increasing balance and reducing the risk of falling in older adults.

Screening and health checks for older adults with neurological conditions

While supporting older adults with the neurological conditions discussed on this page to reduce the risk of falls, the following screening and assessments are available:

  • Balance, Gait and Mobility assessments.
  • Unified Parkinson’s Disease Rating Scale
  • The International Classification of Functioning, Disability and Health Model (more commonly known as the ICF Model) is a helpful tool in identifying all the contributing factors to falls post-stroke.

Who can I collaboratively work with to support older adults with a neurological condition?

A multidisciplinary team for older adults with a neurological condition may consist of a GP, Neurologist, Physiatrist, Physiotherapist, Nurse, Occupational Therapist, Dietitian, and Pharmacist.

More information

For more information, resources, and support about the neurological conditions discussed on this page, visit the following websites:

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