Research paperParkinson's disease patients in institutionalized care
Introduction
Parkinson's disease (PD) is a common neurodegenerative disorder that affects mainly the elderly population causing a progressive functional disability with motor, psychic, and cognitive deterioration. PD carries an increased risk of nursing home placement [1], [2], [3]. In fact, together with stroke and dementia, PD is one of the leading causes of institutionalization [2], [4]. The reported prevalence of PD patients among nursing home residents is in the range from 1.6 to 7% [2], [5], [6], [7], [8], [9]. Prospective cohort studies have indicated that 20–53% of PD patients will eventually require housing in long-term care facilities [3], [10], [11]. Two previous studies reported that the point prevalence of PD patients who are institutionalized was 14% [3], [9]. The risk factors for institutionalization in PD patients have been evaluated in a number of studies [6], [10], [12].
Since only a few studies have analysed the severity of motor, cognitive and ADL functions in patients who are residents of long-term care facilities [6], [7], [13], [14], we carried out a community-based study to investigate these issues. We personally examined the identified residents with PD, and we included clinimetric assessments of the study subjects.
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Subjects and methods
The subjects of this study were residents with PD living in nursing homes and wards offering long-term care in the city of Turku, South-Western Finland. The definition of long-term care in the present study was that the residents were permanently located in that kind of institution. We screened residents with PD from all the long-term care facilities in the city of Turku, i.e. five nursing homes, 15 wards offering long-term care in hospitals of the city, and five private long-term care
Results
At the time of the survey, there were a total of 1228 residents in institutional long-term care facilities in Turku. Out of these subjects, a total of 36 residents with possible PD were identified. Three residents refused to take part in the study. Of the 33 residents who could be evaluated, 11 were excluded after the clinical examination. Two of them had vascular Parkinsonism, four had Lewy body dementia, one had multisystem atrophy and one had drug-induced Parkinsonism. Three residents had
Discussion
The risk factors for nursing home placement in the general population have been found to be old age, living alone, motor disability, impairments of ADL functions and cognitive defects [2], [4]. A number of previous studies have reported that the major risk factors for nursing home placement in PD patients are cognitive disturbances and hallucinations [10], [12]. In our residents with PD, however, severe motor symptoms were the most significant single factor for initiating institutionalization,
Disclosure of interest
The authors declare that they have no conflicts of interest concerning this article.
Acknowledgements
This study was supported by the Finnish Parkinson Foundation. We thank Ewen Macdonald, Pharm. D. for checking the language. We acknowledge the co-operation of the Health Care and Social Services of the city of Turku, which made this study possible.
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