Audit of care home residents with parkinsonism in Salford


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

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 disease31
Vascular parkinsonism8
Parkinsonism-plus syndrome11
Drug induced parkinsonism6

Staging of IPD

Stage
Number of patients
Stage 10
Stage 24
Stage 317
Stage 48

Number of medications

Number of medications
013
132
28
33

Regular physician who reviewed patients

Community geriatrician
31
Neurologist11
Neurolopsychiatrist5
None9

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

Reasons for admission
Number of patients
Infection11
Fall6
Reduced conscious level5

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 plan19
Resuscitation25
Preferred place of care/death18
MDT input
Number of patients
Physiotherapy14
Occupational therapy11
Speech and language therapy19
Dietician22

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.

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