Parkinson's disease patients in institutionalized care

Abstract

Background

The objective of this study was to assess the prevalence and causes of institutionalization of patients with Parkinson's disease (PD) in the city of Turku, Finland. We also analysed the severity of motor, cognitive and ADL functions in residents with PD.

Methods

All the residents with a diagnosis of PD, living in the long-term care facilities in the city of Turku were identified. A total of 33 residents were examined clinically and their medical records were checked. Only the 22 residents who fulfilled the United Kingdom Parkinson's Disease Brain Bank Criteria were enrolled into the study.

Results

There were 1228 residents living in the long-term care facilities in the study area; consequently, 1.8% of the residents had PD. The median age of the residents with PD was 81 years (range 69–91) and the median duration of their disease was 8 years (3–25). The principal causes for institutionalization were severe motor and cognitive impairments and the presence of a debilitating concomitant disorder. Before institutionalization, 19 out of the 22 residents had already needed daily help in many activities of daily living. All the residents with PD in long-term care were receiving levodopa and nearly half of them were experiencing fluctuations in motor function. During 3 years of follow-up, 15 of the 22 residents had died. The median duration of long-term care of the deceased residents was 34 months and the median age at death was 83 years (70–93).

Conclusions

Long-term care facility residents with PD suffer from severe motor, cognitive and ADL impairments.

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.