The effect of functional status impairment on nursing home admission risk among patients with advanced Parkinson’s disease

Abstract

Aims: To estimate the relationship between functional status (FS) impairment and nursing home admission (NHA) risk in Parkinson's disease (PD) patients, and quantify the effect of advanced PD (APD) treatment on NHA risk relative to standard of care (SoC). Materials and methods: PD patients were identified in the Medicare Current Beneficiary Survey (MCBS) (1992-2010). A working definition based on the literature and clinical expert input determined APD status. A logit model estimated the relationship between FS impairment and NHA risk. The effect of levodopa-carbidopa intestinal gel (LCIG) on NHA risk relative to SoC was simulated using clinical trial data (control: optimized oral levodopa-carbidopa IR, ClinicalTrials.gov NCT00660387 and NCT0357994). Results: Non-advanced PD and APD significantly increased NHA risk when controlling for demographics (p < 0.01). APD status was no longer significant after controlling for FS limitations, implying that FS limitations explain the increased NHA risk in APD patients. Reduced impairment in FS in patients with APD treated with LCIG reduced risk of NHA by 13.5% relative to SoC. Limitations: This study applies clinical trial results to real-world data. LCIG treatment might have a different effect on NHA risk for the nationally representative population than the effect measured in the trial. Both data sources employ different instruments to measure FS, instrument wording and study follow-up differed, which might bias our estimates. Finally, there lacks consensus on a definition of APD. The prevalence of APD in this study is high, perhaps due to the specific definition used. Conclusions: Patients with APD experience a higher risk in NHA than those with non-advanced disease. This increased risk in NHA in patients with APD is explained by greater limitations in FS. The relative reduction in risk of NHA for the APD population treated with LCIG is quantitatively similar to doubling Medicaid home care services.

People with Parkinson's disease and housing issues: A scoping review

“…Seven of the publications were produced by a research group in Sweden, 23‐29 and two by researchers in Thailand 30,31 involving co‐authors from Japan, Canada, and the United Kingdom. The remaining publications originated from Norway, 32 the United Kingdom, 33 and the United States 34 . Six of the papers were published in neurology journals, including two with PD/Parkinsonism as the specific scope.…”

“…The studies conducted in Norway 32 and the United States 34 aimed to examine the risk for living in or being admitted to nursing homes. The publication by Vossius et al 32 included analyzes of related costs, compared with the general population.…”

“…Treatments that improve functional status seem to reduce the risk of nursing home admission in non-advanced as well as advanced PD, primarily generated by improved walking ability. 34 Moreover, explorative studies focusing on home and health among people aging with PD showed that this population has a more challenging housing situation than older people in general. 23,25 Subsequently, those studies generated hypotheses for a longitudinal survey study, 24 which hitherto has produced knowledge on the complex dynamics of objective and perceived aspects of housing on the one hand and aspects of health on the other, 26 with detailed knowledge about environmental barriers and housing accessibility as one facet of the findings.…”

The Social Value of Improvement in Activities of Daily Living among the Advanced Parkinson’s Disease Population

“…Over time, reduced functional capabilities heighten a patient's need for increased assistance with day-to-day activities. Individuals with advanced Parkinson's disease (APD) experience a decline in functional status (FS), i.e., the ability to perform daily tasks in order to fulfill self-care needs and usual roles, and to preserve health and well-being (Leidy 1994;American Thoracic Society 2007;Shih et al 2020). This decline has been shown to increase the risk of nursing home admission (NHA) among APD patients in the US (Shih et al 2020).…”

“…Individuals with advanced Parkinson's disease (APD) experience a decline in functional status (FS), i.e., the ability to perform daily tasks in order to fulfill self-care needs and usual roles, and to preserve health and well-being (Leidy 1994;American Thoracic Society 2007;Shih et al 2020). This decline has been shown to increase the risk of nursing home admission (NHA) among APD patients in the US (Shih et al 2020). In addition, limitations in activities of daily living (ADLs), a commonly used measure of FS, contribute to the risk of NHA and health care costs (Chan et al 2002;Fong, Mitchell, and Koh 2015).…”