Parkinson’s Disease

by | 08/07/2025

Risk

  • The symptoms associated with Parkinson’s disease (PD), as well as the effects of the medication prescribed for (PD), may increase the risk of falls.
  • Parkinson’s disease is caused by a loss of nerve cells in part of the brain called the substantia nigra. This leads to a reduction in a chemical called dopamine in the brain.
  • Type plays a vital role in regulating the movement of the body. A reduction in dopamine is responsible for many of the symptoms of Parkinson’s disease.

Reason

  • Individuals living with Parkinson’s disease may have a where their steps get smaller and smaller. This is called ‘festination’, and it can dramatically increase the risk of falling forwards whilst walking.
  • The tremors (involuntary shaking of particular parts of the body) and freezing (the unpredictable, temporary, involuntary ability to move), and increased tone (stiff and inflexible muscles), associated with Parkinson’s disease, can have a negative effect on balance, increasing the risk of falls.
  • Freezing can be dangerous because the beginning and end of these episodes are unpredictable. It may also affect other parts of the body or the individual speech. The cause of freezing is unknown. In people that experience it, freezing mostly happens when they are having an “off” period, or are due for their next dose of dopaminergic medication.
  • The effect of medication wearing off may cause freezing, and/or unwanted movements, which increases the risk of the person with Parkinson’s disease falling. If the medication doses are too low or too high, this can also have an adverse effect on the person’s ability to mobilise without falling.  In some cases, the person may put themselves on the floor to avoid falling.
  • A person with Parkinson’s disease can also experience a wide range of other physical and psychological symptoms including hallucinations and paranoia. Some of these may be side effects of the dopaminergic medication.

Intervention

  • Understand that, in a person with Parkinson’s disease, their ability to mobilise, or do other activities, may vary dramatically at different times of the day, depending on the timing of their medication. For example, a person may be able to mobilise independently in the morning, but may require a wheelchair in the afternoon, due to experiencing unwanted movements at this point of the day.
  • Freezing:
    • Be aware of what situations can trigger a freezing episode:
      • Episodes can happen at any time but tend to happen more often when the person is initiating or starting to move (e.g. standing to walking).
      • They are more likely to have freezing episodes when they are walking through doorways, turning in a corner, turning around, or stepping from one type of surface to another (e.g. tile to carpet).
      • Multi-tasking, stopping, or slowing down your pace while walking can also trigger an episode.
      • They may also have more freezing during stressful situations or when surrounded by crowds.
  • Prepare strategies in advance.
  • Encourage marching (with verbal cues of “left, right, left, right”, or “lift, lift, lift, lift”).
  • Get the person to shift the weight of the body from one leg to another.
  • Encourage the person to listen to music and step with the rhythm. Wearing earphones can be helpful.
  • Home, sing, or count, and encourage the person to do this themselves, either out loud, or in their head.
  • Ask the person to imagine a line to step over, or to focus on a target on the floor to step on when they are having trouble initiating walking.
  • Use a mobile laser device to create a line in front of them, or stick lines of tape at stepping distance apart, for the person to practise stepping.
  • Encourage turning by walking half a circle or square, instead of by turning on the spot.
  • Remain calm. If an individual is having a freezing episode, be careful not to push the person to move before they are ready, as this may cause the person with Parkinson’s disease to lose balance and fall.
  • Wait patiently for several seconds to see if the episode passes.
  • If the person is unable to move without assistance, encourage the person to try marching or counting.
  • If verbal cues do not work, try placing a pen perpendicular to the person and ask them to step over it.
  • Or try, with your hands gently positioned each side of the person’s pelvis, to help transfer their weight side to side, from one leg to the other. Make sure that your weight is on the same leg as their weight is (i.e. your left and their left) so that you keep your balance!
  • Be aware of the other symptoms of Parkinson’s disease, which include depression and anxiety, loss of sense of smell (anosmia), problems sleeping (insomnia), and memory problems.
  • Refer to a qualified physiotherapist, who can teach techniques that reduce the risk of falling.
  • Be aware of medication timing. And show the person receives their medication in a timely manner. Request a medication review through your GP or community pharmacist, if the individual’s tremors, freezing, or balance, or other symptoms have worsened.
  • Request a Parkinson’s review through the GP, or the Parkinson’s Nurse Specialist.

Considerations

  • It is important that the individual’s capacity to make decisions around each specific area is considered and documented.
  • Individuals who have capacity regarding these decisions can make choices about what they want to do. You need to document their ability to make this decision, as well as what they chose every time is it relevant.
  • You may need to inform them of the benefits and risks, if they are not aware, or you may need to remind them if they have difficulty remembering things.
  • If the individual is assessed as not having capacity regarding a decision, this needs to be documented appropriately and interventions need to be implemented and documented as part of a Best Interests Decision, using appropriate paperwork.