Falls Risk Assessment

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Anti-Parkinson’s drugs

Fall incidents in patients with Parkinson’s disease (PD) are frequent and recurrent, with 45–68% of people falling annually 1 and two-thirds of these falling recurrently.2 Patients with PD are usually on a high number of FRIDs putting them at even a higher risk of falls.3 It is, essential to manage this disease and understand the impact of Anti-Parkinson’s medications and FRIDs on patients’ fall risk.4,5

  • Determine whether the patient has neurogenic orthostatic hypotension (nOH) by monitoring 3-minute SBP of the patient, their sitting blood pressure, supine blood pressure as well as heart rate. If nOH is detected the consider:6
    • Adding Fludrocortisone, Midrodineb, Domperidone and Physostigmine


  • Request specialist advice if a decrease in the dose of particular PD medication is required.6
  • Consider reviewing the patient if on any drugs that can worsen the symptoms such as:7
    • Antipsychotics
    • Anti-emetics

References

  1. Ashburn A, Stack E, Pickering R, Ward C. A community‐dwelling sample of people with Parkinson's disease: characteristics of fallers and non‐fallers. Age ageing. 2001;30(1):47-52.

  2. Allen N, Sherrington C, Paul S, Canning C. Balance and falls in Parkinson's disease: A meta‐analysis of the effect of exercise and motor training. Mov Disord. 2011;26(9):1605-15.

  3. Haasum Y, Fastbom J, Johnell K. Use of fall-risk inducing drugs in patients using anti-Parkinson drugs (APD): a Swedish register-based study. PLoS ONE. 2016;11(8):1-10.

  4. Critchley R, Khan S, Yarnall A, Parker M, Deehan D. Occurrence, management and outcomes of hip fractures in patients with Parkinson's disease. Br Med Bull. 2015;115(1).

  5. Canning C, Paul S, Nieuwboer A. Prevention of falls in Parkinson's disease: a review of fall risk factors and the role of physical interventions. Neurodegen Dis Manage. 2014; 4(3): 203–21.

  6. Isaacson S, Skettini J. Neurogenic orthostatic hypotension in Parkinson’s disease: evaluation, management, and emerging role of droxidopa. Vasc Health Risk Manag. 2014;10:169.

  7. Van der Marck MA, Klok MPC, Okun MS, Giladi N, Munneke M, Bloem BR, et al. Consensus-based clinical practice recommendations for the examination and management of falls in patients with parkinson's disease. Parkinsonism Relat Disord. 2014;20(4):360-369.

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