Original Research
Living in a rural area: a potential risk factor for falls in people with Parkinson disease
AUTHORS
Xing-Xing Zheng1 Master's Degree, Resident Physician 
Lei Wu2 Medical PhD, Deputy Chief Physician
Chen Yang3 Master's Degree, Resident Physician
Hai-Ting Yang4 Master's Degree, Resident Physician
Xiao-Ling Ding5 Master's Degree, Professor *
AFFILIATIONS
1, 2, 3, 5 Department of Neurology, Provincial Hospital Affiliated to Anhui Medical University, Hefei 230000, Anhui Province, China
4 Department of Neurology, Sir Run Run Hospital Nanjing Medical University, Nanjing 210000, Jiangsu Province, China
ACCEPTED: 11 March 2022
Now published, see the full article 
Early Abstract:
Introduction: Falls are prevalent in patients with Parkinson’s disease (PD). Previous work focused on the impact of motor and non-motor symptoms on falls and ignored the impact of environmental factors, such as residence, economic level, and nursing status. We aimed to investigate the prevalence and risk factors of falls in patients with PD and explore the impact of residence on falls.
Methods: A cross-sectional study of 100 patients with PD was carried out. Patients were recruited from Anhui Provincial Hospital (Hefei, Anhui) between July 2017 and December 2020. Participants were grouped based on whether they had fallen in the previous 3 months, and demographic information was collected through detailed interviews. In addition, the severity of motor symptoms, cognitive function, and self-care abilities were assessed with the Unified Parkinson's Disease Rating Scale part III (the UPDRS-III), the Hoehn-Yahr (H&Y) scale, the Mini-Mental State Examination (MMSE), and the Barthel Index. The results were analyzed using Student's t-test, Mann-Whitney U-test, chi-square test, and multivariate binary logistic regression analyses.
Results: A total of 42% of the patients fell in the last 3 months. The patients who fell were older and with a longer disease period, a higher UPDRS-III score, a higher H&Y stage, a lower MMSE score, and a lower Barthel Index score (all P < 0.05). According to the logistic regression analysis, living in a rural area (OR = 3.34, 95% CI 1.15–9.65), MMSE < 24 (OR = 4.79, 95% CI 1.17–19.65), having sleep disorders (OR = 4.97, 95% CI 1.74–14.2), and having a high UPDRS-III score (OR = 1.07, 95% CI 1.02–1.11) were independent risk factors for falls. The incidence of falls was higher in rural areas. Urban and rural patients showed different levels of disease severity; rural patients had higher H&Y stages, higher UPDRS-III scores and lower Barthel Index scores.
Conclusion: Falls are caused by a variety of factors in people with Parkinson's disease. Multidimensional factors should be considered comprehensively to develop a personalized plan to prevent falls in Parkinson's disease patients.