In our August 2011 What’s New in the Patient Safety World column “Problems Managing Medications in Parkinson’s Disease” we highlighted an article
A new study from The Netherlands (Gerlach 2012) found that 21% of Parkinson patients admitted to a hospital experienced deterioration of motor function and 33% had one or more complications. Moreover, 26% received incorrect anti-Parkinson medications, which was the most significant reason associated with clinical deterioration. Infections also increased the risk for deterioration (though not after adjustment for confounding variables) and of patient-related factors higher doses of L-dopa were associated with increased risk of deterioration.
Patients with Parkinson’s often require specific timing of their medications in order to minimize the “on-off” phenomenon and to avoid hyperkinesias. This results in their requiring multiple dosing throughout the day and often at unusual times. It is very difficult for hospitals to have medication administration times that correspond to how those patients take their drugs at home. One suggested intervention is to allow the patients to self-medicate with their anti-Parkinson’s medications while hospitalized.
Interestingly, the researchers found the situation no better in those patients admitted to neurological wards rather than other wards. This simply suggests an overall relative lack of understanding of Parkinson’s disease in healthcare workers who work primarily in hospitals. It also reflects some of the rigid medication administration practices we have in most hospitals.
The results were based upon patient-supplied answers to a questionnaire. However, when a sampling of inpatient charts was reviewed there was a striking paucity of recognition of deterioration by physicians and nursing staff.
In a review on the perioperative management of the geriatric patient, Ersan notes that Parkinson’s patients require special attention (Ersan 2011). She notes that withholding medications in patients who are NPO can cause significant worsening of symptoms, including enough stiffening of chest wall muscles to cause hypoxia. In addition, tremor and dysphagia may worsen.
We’ve discussed before the phenomenon of deterioration in functional status that often occurs when a geriatric person is admitted to a hospital. That applies especially to patients with Parkinson’s whether they are geriatric or not. They really do require special attention to avoid potential complications and to minimize the risk of that functional deterioration.
Parkinson’s is a tough disease for patients and their families/caregivers. The complexities and fragmented nature of our healthcare system further exacerbate the difficulties they have. Recognizing these vulnerabilities when patients with Parkinson’s are admitted to hospitals is a first step in preventing complications, minimizing hospital lengths of stay, and avoiding functional deterioration.
Gerlach OHH, Broen MPG, van Domburg PHMF, et al. Deterioration of Parkinson's disease during hospitalization: survey of 684 patients. BMC Neurology 2012, 12: 13 (8 March 2012)
Ersan T. Perioperative Management of the Geriatric Patient. Medscape Reference. Updated: June 20, 2011
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