By Dr Cheng Khuang Lim, ST5, Salford Royal Foundation Trust

Parkinson’s Advanced MasterClass 34A, November 2018

 

Introduction

Parkinsonism is common in care home. The prevalence and demographics of care home patients with parkinsonism remains poorly investigated. Previous studies suggested that around 5-7% care home patients have parkinsonism. (Susan L. Mitchell MD 1996) (Robert J.Buchanana 2002) The 3 year mortality was 50% in care home with parkinsonism. (Fernandez HH 2002) Despite that, the diagnosis and management of care home patients with parkinsonism were suboptimum. (JP. 1991) (Weerkamp NJ 2012) (Makoutonina M 2010)

Objective

  1. Understand the demographics of care home residents with parkinsonism in Salford Royal Foundation Trust.
  2. Investigate reason for admission of care home residents with parkinsonism.
  3. To review the quality of advanced care plan in care home residents with Parkinsonism.

Methods

We obtained a list of care home residents with idiopathic Parkinson’s disease, vascular parkinsonism and parkinsonism plus syndrome from community geriatricians in February 2018. Following this, we collected data about patient demographic data, hospital admissions in the last 24 months and advanced care plan using EPR. The data was processed using Microsoft Excel.

Results

56 patients (27 male) with the mean age of 79.89 (SD 8.14) w1ere included in this study. 36 of them also have the diagnosis of dementia.

Parkinsonism
Number of patients
Idiopathic parkinson’s disease 31
Vascular parkinsonism 8
Parkinsonism-plus syndrome 11
Drug induced parkinsonism 6

 

Staging of IPD

Stage
Number of patients
Stage 1 0
Stage 2 4
Stage 3 17
Stage 4 8

 

Number of medications

Number of medications
 
0 13
1 32
2 8
3 3

Regular physician who reviewed patients

Community geriatrician
31
Neurologist 11
Neurolopsychiatrist 5
None 9

34 of them had at least 1 admission in the last 24 months.

Reasons for admission
Number of patients
Infection 11
Fall 6
Reduced conscious level 5

4 patients passed away since January 2018. None of them had up-to-date advanced care plan and one of them died in ED after CPR.

 
Number of patients
Advanced care plan 19
Resuscitation 25
Preferred place of care/death 18

 

MDT input
Number of patients
Physiotherapy 14
Occupational therapy 11
Speech and language therapy 19
Dietician 22

 

Conclusion

The management of care home residents with parkinsonism is suboptimum. We should aim to improve their care in community and hopefully this can reduce unnecessary hospital stay.

Bibliography

  • Fernandez HH, Lapane KL. “Predictors of mortality among nursing home residents with a diagnosis of Parkinson’s disease.” Med Sci Monit, 2002.
  • JP., Larsen. ” Parkinson’s disease as community health problem: Study in Norwegian nursing homes. The Norwegian Study Group of Parkinson’s Disease in the Elderly. BMJ 1991;303:741e743.” BMJ, 1991.
  • Makoutonina M, Iansek R, Simpson P. “Optimizing care of residents with Parkinsonism in supervised facilities. Parkinsonism Relat Disord 2010;16:351e355.” Parkinsonism Relat Disord , 2010.
  • NICE. “NICE guideline [NG71] Parkinson’s disease in adults .” 2017.
  • Robert J.Buchanana, SuojinWangb, ChunfengHuangc, Patricia Simpsond, Bala V.Manyame. “Analyses of nursing home residents with Parkinson’s disease using the minimum data set.” Parkinsonism & Related Disorders, 2002.
  • Susan L. Mitchell MD, FRCP(C) Dan K. Kiely MPH Douglas P. Kiel MD, MPH Lewis A. Lipsitz MD. “The Epidemiology, Clinical Characteristics, and Natural History of Older Nursing Home Residents with a Diagnosis of Parkinson’s Disease.” Journal of American Geriatric Society, 1996.
  • UK Parkinson’s Excellence Network. “UK Parkinson’s Audit.” 2015.
  • Weerkamp NJ, Zuidema SU, Tissingh G, et al. “Motor profile and drug treatment of nursing home residents with Parkinson’s disease. .” J Am Geriatr Soc, 2012.