Camicioli Richard, Morris Meg E, Pieruccini-Faria Frederico, Montero-Odasso Manuel, Son Surim, Buzaglo David, Hausdorff Jeffrey M, Nieuwboer Alice
Department of Medicine (Neurology) and Neuroscience and Mental Health Institute University of Alberta Edmonton Alberta Canada.
La Trobe University, Academic and Research Collaborative in Health & Healthscope Melbourne Victoria Australia.
Mov Disord Clin Pract. 2023 Sep 2;10(10):1459-1469. doi: 10.1002/mdc3.13860. eCollection 2023 Oct.
People living with Parkinson's disease (PD) have a high risk for falls.
To examine gaps in falls prevention targeting people with PD as part of the Task Force on Global Guidelines for Falls in Older Adults.
A Delphi consensus process was used to identify specific recommendations for falls in PD. The current narrative review was conducted as educational background with a view to identifying gaps in fall prevention.
A recent Cochrane review recommended exercises and structured physical activities for PD; however, the types of exercises and activities to recommend and PD subgroups likely to benefit require further consideration. Freezing of gait, reduced gait speed, and a prior history of falls are risk factors for falls in PD and should be incorporated in assessments to identify fall risk and target interventions. Multimodal and multi-domain fall prevention interventions may be beneficial. With advanced or complex PD, balance and strength training should be administered under supervision. Medications, particularly cholinesterase inhibitors, show promise for falls prevention. Identifying how to engage people with PD, their families, and health professionals in falls education and implementation remains a challenge. Barriers to the prevention of falls occur at individual, environmental, policy, and health system levels.
Effective mitigation of fall risk requires specific targeting and strategies to reduce this debilitating and common problem in PD. While exercise is recommended, the types and modalities of exercise and how to combine them as interventions for different PD subgroups (cognitive impairment, freezing, advanced disease) need further study.
帕金森病（PD）患者跌倒风险很高。
作为老年人跌倒全球指南特别工作组的一部分，研究针对PD患者的跌倒预防差距。
采用德尔菲共识法确定PD患者跌倒的具体建议。进行当前的叙述性综述作为教育背景，以确定跌倒预防方面的差距。
最近的一项Cochrane综述推荐了针对PD的运动和结构化体育活动；然而，推荐的运动和活动类型以及可能受益的PD亚组需要进一步考虑。步态冻结、步态速度降低和既往跌倒史是PD患者跌倒的危险因素，应纳入评估以识别跌倒风险并确定干预目标。多模式和多领域的跌倒预防干预可能有益。对于晚期或复杂的PD，平衡和力量训练应在监督下进行。药物，特别是胆碱酯酶抑制剂，在预防跌倒方面显示出前景。确定如何让PD患者、他们的家人和卫生专业人员参与跌倒教育和实施仍然是一个挑战。跌倒预防的障碍存在于个人、环境、政策和卫生系统层面。
有效降低跌倒风险需要有针对性的具体策略，以减少PD中这个使人衰弱且常见的问题。虽然推荐运动，但运动的类型和方式以及如何将它们作为针对不同PD亚组（认知障碍、冻结、晚期疾病）的干预措施进行组合需要进一步研究。
