Evaluation of Patients with Parkinson’s Disease in Intensive Care Units: A Cohort Study

Réa-Neto, Álvaro; Vesco, Bruna Cassia Dal; Bernardelli, Rafaella Stradiotto; Kametani, Aline M; Oliveira, Mirella Cristine de; Teive, Hélio Afonso Ghizoni

doi:10.1155/2021/2948323

Cited by 4 publications

(4 citation statements)

References 15 publications

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“…ICU admissions among persons with PD are often unrelated to PD duration or severity ( Paul et al, 2019 ), and ICU mortality data are overall mixed. In one study comparing ICU admissions between persons with and without PD in Brazil, those with PD had longer hospital stays but did not experience an increased mortality risk resulting from their ICU admission ( Réa-Neto et al, 2021 ). However, in a second study involving a random sample of elderly Medicare beneficiaries, ICU length of stay was associated with an increased risk of 1-year mortality among ICU survivors ( Moitra et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

Unique characteristics of end-of-life hospitalizations in Parkinson disease

Aamodt,

Dahodwala,

Bilker

et al. 2023

Front. Aging Neurosci.

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IntroductionPersons with Parkinson disease (PD) are hospitalized at higher rates, have longer lengths of stay, and are more likely to die in the hospital than age-matched peers. Although prior studies have compared inpatient outcomes between persons with and without PD, little is known about inpatient outcomes across the PD trajectory, or whether hospitalizations occurring in the last 6 months of life differ from earlier hospitalizations.MethodsThis cross-sectional study compared Medicare Part A and B beneficiaries aged 65 and older with a qualifying PD diagnosis who were hospitalized in 2017: decedents who died between 7/1/2017 and 12/31/2017 from all causes and were hospitalized at least once in their last 6 months of life, and non-decedents who were hospitalized between 1/1/2017 and 6/30/2017 and lived 6 or more months after discharge. End-of-life (EoL) hospitalizations were defined as those occurring in the last 6 months of life. Descriptive analyses compared patient-level variables (e.g., demographics, comorbidities, treatment intensity) and encounter-level variables (e.g., length of stay, total charges) between groups. Multivariable logistic regression models also compared rates of intensive care unit (ICU) admission and 30-day readmission between hospitalized decedents and hospitalized non-decedents, adjusting for age, sex, race/ethnicity, rural residence, and Charlson Comorbidity Index Score.ResultsOf 26,492 Medicare decedents with PD, 16,187 (61.1%) were hospitalized in their last 6 months of life. Of 347,512 non-decedents with PD, 62,851 (18.1%) were hospitalized in a 6-month period. Hospitalized decedents were slightly older than hospitalized non-decedents (82.3 [SD 7.40] vs. 79.5 [SD 7.54] years) and had significantly more comorbidities. Compared to non-EoL hospitalizations, EoL hospitalizations were slightly longer (5 [IQR 3–9] vs. 4 [IQR 3–7] days) and more expensive based on total charges per admission ($36,323 [IQR 20,091-69,048] vs. $32,309 [IQR 18,789–57,756]). In covariate-adjusted regression models using hospitalized non-decedents as the reference group, hospitalized decedents were more likely to experience an ICU admission (AOR 2.36; CI 2.28–2.45) and 30-day readmission (AOR 2.43; CI 2.34–2.54).DiscussionHospitalizations occurring in the last 6 months of life among persons with PD in the United States are longer, more costly, and more resource intensive than earlier hospitalizations and may stem from medical comorbidities. Once hospitalized, ICU admission and 30-day readmission may aid in prognostication and serve as markers of transition to the EoL period.

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Section: Discussionmentioning

confidence: 99%

Unique characteristics of end-of-life hospitalizations in Parkinson disease

Aamodt,

Dahodwala,

Bilker

et al. 2023

Front. Aging Neurosci.

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“…Also was the severity at admission: PD patients had a lower level of consciousness and higher APACHE II score but there was no difference for the requirement of invasive mechanical ventilation or SOFA score. When controlling for these factors, PD did not remain an independent predictor of death in ICU [24 ▪ ]. Despite its obvious methodological limitations (notably lack of data regarding the severity of PD patients or their functional status), this study suggests that beyond a higher severity at admission, the prognosis of PD patients in the ICU is not necessarily worse compared to non PD patients.…”

Section: Parkinson's Diseasementioning

confidence: 59%

How to manage catatonia, Parkinson and dementia in ICU

Attali,

Calligaris,

Grabli

et al. 2024

Current Opinion in Critical Care

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Purpose of review The rising prevalence of neurodegenerative and mental disorders, combined with the challenges posed by their frailty, has presented intensivists with complex issues in the intensive care unit (ICU). This review article explores specific aspects of care for patients with catatonia, Parkinson's disease (PD), and dementia within the context of the ICU, shedding light on recent developments in these fields. Recent findings Catatonia, a neuropsychiatric syndrome with potentially life-threatening forms, remains underdiagnosed, and its etiologies are diverse. PD patients in the ICU present unique challenges related to admission criteria, dopaminergic treatment, and respiratory care. Dementia increases the risk of delirium. Delirium is associated with long-term cognitive impairment and dementia. Summary While evidence is lacking, further research is needed to guide treatment for ICU patients with these comorbidities.

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“…People with a clinical diagnosis of Parkinson’s disease (PD) experience more frequent and prolonged hospitalizations than their age-matched peers ( Aminoff et al, 2011 ; Chou et al, 2011 ; Hobson et al, 2012 ; Kowal et al, 2013 ; Shahgholi et al, 2017 ; Su et al, 2018 ). Most hospitalizations occur in general wards and result from a comorbid disorder or health crisis, such as respiratory and urinary tract infections, cardiovascular diseases, falls, and fractures ( Woodford and Walker, 2005 ; Braga et al, 2014 ; Lubomski et al, 2015 ; Gil-Prieto et al, 2016 ; Okunoye et al, 2020 ; Réa-Neto et al, 2021 ). It is well documented that during hospitalizations, person with PD (PwP) is at a higher risk of complications, including falls, medication errors, development of delirium and psychosis, and overall decline of their pre-existing motor and non-motor symptoms of PD ( Derry et al, 2010 ; Gerlach et al, 2013 ; Lubomski et al, 2015 ; Skelly et al, 2017 ; Magnuszewski et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

More than medications: a patient-centered assessment of Parkinson’s disease care needs during hospitalization

Shurer,

Golden,

Mihas

et al. 2023

Front. Aging Neurosci.

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BackgroundParkinson’s disease (PD) increases the risk of hospitalization and complications while in the hospital. Patient-centered care emphasizes active participation of patients in decision-making and has been found to improve satisfaction with care. Engaging in discussion and capturing hospitalization experience of a person with PD (PwP) and their family care partner (CP) is a critical step toward the development of quality improvement initiatives tailored to the unique hospitalization needs of PD population.ObjectivesThis qualitative study aimed to identify the challenges and opportunities for PD patient-centered care in hospital setting.MethodsFocus groups were held with PwPs and CPs to capture first-hand perspectives and generate consensus themes on PD care during hospitalization. A semi-structured guide for focus group discussions included questions about inpatient experiences and interactions with the health system and the clinical team. The data were analyzed using inductive thematic analysis.ResultsA total of 12 PwPs and 13 CPs participated in seven focus groups. Participants were 52% female and 28% non-white; 84% discussed unplanned hospitalizations. This paper focuses on two specific categories that emerged from the data analysis. The first category explored the impact of PD diagnosis on the hospital experience, specifically during planned and unplanned hospitalizations. The second category delves into the unique needs of PwPs and CPs during hospitalization, which included the importance of proper PD medication management, the need for improved hospital ambulation protocols, and the creation of disability informed hospital environment specific for PD.ConclusionPD diagnosis impacts the care experience, regardless of the reason for hospitalization. While provision of PD medications was a challenge during hospitalization, participants also desired flexibility in ambulation protocols and an environment that accommodated their disability. These findings highlight the importance of integrating the perspectives of PwPs and CPs when targeting patient-centered interventions to improve hospital experiences and outcomes.

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Evaluation of Patients with Parkinson’s Disease in Intensive Care Units: A Cohort Study

Cited by 4 publications

References 15 publications

Unique characteristics of end-of-life hospitalizations in Parkinson disease

Unique characteristics of end-of-life hospitalizations in Parkinson disease

How to manage catatonia, Parkinson and dementia in ICU

More than medications: a patient-centered assessment of Parkinson’s disease care needs during hospitalization

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