Falls in people with Parkinson's disease: A prospective comparison of community and home-based falls

Background Falls are common and debilitating in people with Parkinson's disease (PD) and restrict participation in daily activities. Understanding circumstances of falls in the community and at home may assist clinicians to target therapy more effectively. Objective: To compare the characteristics of community and home fallers and the circumstances that contribute to falls in people living with PD. Methods: People with mild-moderately severe PD (n = 196) used a daily falls diary and telephone hotline to report prospectively the occurrence, location and circumstances of falls over 14 months. Results: 62% of people with PD fell, with most falling at least once in the community. Compared to people who fell at home, the community-only fallers had shorter durations of PD (p = 0.012), less severe disease (p = 0.008) and reported fewer falls in the year prior to the study (p = 0.003). Most falls occurred while people were ambulant, during postural transitions and when medication was working well. Community-based falls were frequently attributed to environmental factors such as challenging terrains (p < 0.001), high attention demands (p = 0.029), busy or cluttered areas (p < 0.001) and tasks requiring speed (p = 0.020). Physical loads were more often present in home than community-based falls (p = 0.027). Conclusion: Falls that occur in the community typically affect people with earlier PD and less severe disease than home-based falls. Individuals experiencing community-based falls may benefit from physiotherapy to manage challenging environments and high attention demands.