Motor Profile and Drug Treatment of Nursing Home Residents with Parkinson's Disease

Abstract

These findings show that PD in nursing home residents is characterized by severe motor impairment and a high proportion of daily "off" time, which underscores the need for better management of PD in nursing homes, for example within specialized institutions or with periodic consultations by a movement disorders expert.

Nonmotor Symptoms in Nursing Home Residents with Parkinson's Disease: Prevalence and Effect on Quality of Life

“…Sustained nighttime dopaminergic treatment has been shown to be beneficial for motor function and nocturnal sleep disturbances such as pain, cramps, and restless limbs . Dopaminergic undertreatment in the NH residents, which has been reported previously, may therefore also be partly responsible for the high scores on certain PDSS items …”

“…Community‐based studies have reported symptoms in the lower gastrointestinal tract and sleep and sexual dysfunction in approximately 50% of the elderly population, whereas nonpsychotic neuropsychiatric symptoms were reported in 25% of elderly adults without PD . Many of the NH residents appeared to be undertreated with dopaminergic medication, with a high percentage of the participants being “off” for a significant part of the day . This undertreatment may, in addition to contributing to “motor offs,” lead to the nonmotor state wearing off and thus contribute to the high prevalence and severity of NMS …”

“…Residents with PD stay in these institutions for approximately 3 years, yet little is known about the clinical characteristics and symptoms of this group, which mostly consists of people who are in the later stage of their disease. Two recent studies demonstrated that NH residents with PD were undertreated for motor symptoms, although interventions led to marked improvements in residents' functioning and quality of life . No prior study has focused on the prevalence and effect of nonmotor symptoms (NMS), such as sleep problems, autonomic dysfunction, and neuropsychiatric features, in this population.…”

Revolutionising management of chronic disease: the ParkinsonNet approach

“…Recent exploratory work suggests that this network model has the potential to enhance care not only in the community but also for patients living in residential care and nursing homes. 24 The model may also be beneficial for patients with other forms of chronic disease, where management is similarly impaired by lack of expertise among professionals, poor interprofessional collaboration, and a lack of tools to empower patients. 25 26 We Established national Parkinson registry with transparent information on health services delivered, quality indicators, outcomes at patient level, and audits Insufficient insight into actual quality of care Transparency allows good professionals to display expertise Transparency seen as threat to professional autonomy Keep decision support optional instead of compulsory Electronic decision support seen as cumbersome by experienced professionals Implement value based care (fee for outcome) Cost savings partially offset by "zero sum competition" † *Allowing too many professional to participate conflicts with our aim to increase the caseload among a restricted number of specialists.…”

Applause sign in advanced Parkinson's disease

“…Patients scoring <18 on the Mini Mental State Examination (MMSE) e representing moderate to severe cognitive decline which could hamper obtaining reliable clinimetrics e were excluded. An extensive description of patient recruitment has been published elsewhere and this study is part of a large project on PD in Dutch nursing homes [12].…”