Staying Upright: The Lesser Known role of Orthostatic Hypotension in Parkinson’s-Related Falls
By: Natalie Wilcox
Falls and the fear of falling are a major contributor to poor quality of life for people with Parkinson’s Disease. People with Parkinson’s Disease have double the risk for falls and associated bone fractures when compared to others their age with over half of the population having at least one fall a year (LeWitt, Kymes and Hauser, 2020). In a report released by the city of Winnipeg in 2018 it was indicated that falls were the leading cause of injury-related hospitalizations for older Canadian adults. A fall is also the highest risk factor for a subsequent fall, and can lead to apprehension around falling. Therefore it is extremely important to help reduce all factors that are going to cause older adults to fall. This is why it is so important to identify the cause of falls in particular populations.
The assumption is that people with Parkinson’s disease are falling due to condition-related motor issues, and although this is part of the story it is definitely not all of it. One of the largest underrecognized factors is the prevalence of neurogenic orthostatic hypotension in people with Parkinson’s disease. Orthostatic hypotension is characterized by a dramatic drop in blood pressure with postural changes such as standing up form a sitting position that can lead to fainting and falls. In people with Parkinson’s this can occur when nervous system damage leads to issues with the bodies unconscious control of blood pressure when moving to a standing position.
There are two main reasons that Parkinson’s disease can lead to orthostatic hypotension, one is that the neurogenic portion of the condition is causing the body to have systemic malfunctions that decrease postural blood pressure, or that the hypotension developed as a result of treatment for Parkinson’s disease such as Levodopa. Autonomic failure or the body’s decreased ability to regulate its own internal processes may be a contributing factor to the neurogenic development of orthostatic hypotension, especially as autonomic failure is a largely attributed to Parkinson’s disease. Also, dopaminergic therapy such as Levodopa has been found to cause hypotensive responses even in conventional dosing.
Between the effects of orthostatic hypotension and traditional Parkinson’s symptoms, it is important to have preventative measures in place to prevent falls. This can come in the form of medications to make sure that blood pressure remains high and elevated fainting and falls from orthostatic hypotension. Implementing new techniques such as actively crossing legs and tensing them before standing, physical therapy to help with balance or using mobility assistors such as canes and walkers to help with mobility and confidence to prevent falls.
Overall, it is important to think outside the box and examine all the risk factors someone with Parkinson’s may be experiencing to help prevent falls.
LeWitt, P. A., Kymes, S., & Hauser, R. A. (2020). Parkinson Disease and Orthostatic Hypotension in the Elderly: Recognition and Management of Risk Factors for Falls. Aging and disease, 11(3), 679–691. https://doi.org/10.14336/AD.2019.0805
Menzies, C. (2018, October 29). The Burden of Falls in Canada. Staying on your Feet. Retrieved November 20, 2021, from https://preventfalls.ca/professionals/backgrounders/the-burden-of-falls-in-canada_oct2018/.