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PD Falls – Multifactorial Prevention — SCE Neurology MCQ

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ModerateMovement DisordersPD Falls – Multifactorial PreventionSCE Neurology

A 65-year-old woman with PD has recurrent falls. Fall risk assessment shows she has postural instability (pull test positive), orthostatic hypotension (30 mmHg systolic drop on standing), freezing of gait, and she is on a sedating medication (clonazepam for RBD). What is the recommended multifactorial falls prevention approach?

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Correct answer: A — Multifactorial approach: (1) treat orthostatic hypotension (medication review, midodrine, compression stockings), (2) reduce sedating medications (consider melatonin instead of clonazepam), (3) physiotherapy for balance and gait training with cueing strategies for FOG, (4) home hazard assessment and modifications, (5) vision review, (6) footwear assessment, (7) bone health assessment

Falls prevention in PD requires a multifactorial approach addressing ALL modifiable risk factors: OH (medication review, midodrine, compression stockings, physical countermanoeuvres), sedating medications (reduce/switch — melatonin for RBD instead of clonazepam), balance training (PD-specific physiotherapy), FOG management (cueing strategies, footwear), home hazard assessment (occupational therapy), vision correction, bone health (DEXA, vitamin D, bisphosphonates if osteoporotic — to reduce fracture impact). NICE NG71 and NICE CG161 Falls Prevention both apply. A: Multiple domains needed. C: Comprehensive approach required. D: Falls can be reduced by 20–40% with multifactorial intervention. E: Hip protectors are one component.

Reference: NICE NG71; NICE CG161 Falls Prevention