The impact of the first COVID-19 wave on patients with Parkinson’s disease in Lancashire

Introduction

The unprecedented impact on healthcare services during the first wave of the COVID-19 pandemic in the UK are well documented.

Patients with Parkinsonian disorders (PwP) require regular monitoring with the majority of interaction taking place face to face within established healthcare settings.

In our study we set out to analyse the impact of the COVID-19 pandemic on our Parkinson’s disease service and our patient cohort.

Objective

We wanted to investigate the impact on the first wave of COVID-19 on the in patient management of patient’s with Parkinsonian disorders with particular emphasis on:

• Were patients with Parkinson’s reviewed by the Parkinson’s specialist nurses within 24 hours of admission?
• What was the effect of the first COVID-19 wave on the admission rate of patients with Parkinson’s disease?
• What was the cause for hospital admissions during the first wave of the COVID-19 pandemic?
• Was there an increase in Parkinson’s related issues leading to hospital admission?
• Was there any change in the mortality rate in patient’s with Parkinson’s disease?

Service development

The Parkinson’s disease service in the Lancashire region provides both in patient and outpatient care covering a population of approximately 1.5 million people.

The service is based at the Royal Preston Hospital including three specialist Parkinson’s nurses and one consultant neurologist with an interest in movement disorders.

Prior to the pandemic an electronic alert system was implemented on the trust’s electronic patient record system. Patients with a known diagnosis of a Parkinsonian disorder who attend for unscheduled care (emergency department attendance or hospital admission) trigger an electronic alert to the Parkinson’s Specialist nurse team.

Patient’s with Parkinsonian disorders can either be reviewed remotely or face to face by our specialist nursing team. Particular emphasis is made on the importance of administration of anti-Parkinson medications with prompt advice given with regards to alternative routes of administration depending on the clinical situation.

During the first wave of the COVID-19 pandemic, reduction in face to face interaction lead to increasing reliance on remote based technology.

Results

We analysed data between March – June 2020

37 patients with Parkinson’s disease were admitted to hospital. 8 patient’s had co-existing Parkinson’s disease dementia.

Age range 64 – 94 years; mean 78 years. Admission length range 1 – 23 days; mean 7 days.

26/37 (70%) patients were reviewed by the Parkinson’s nurse specialist team either remotely or in person.

12/37 (32%) patients were admitted with a complication attributable to Parkinson’s disease. Including increasing falls 4 patients, symptomatic hypotension 4 patients, constipation 1 patient, worsening hallucinations 1 patient, worsening dyskinesia 1 patient and worsening rigidity 1 patient.

5 patients in total were admitted due to covid-19; with 3 patients (60%) unfortunately dying.

7/37 (19%) patients died during their hospital admission. Causes of death included COVID-19 3 patients, non-covid pneumonia 2 patients, urosepsis 1 patient and ischaemic stroke 1 patient.

There was a 43% reduction in overall admission rates in patients with Parkinson’s disease compared to March – June 2019.

Conclusions

Despite challenging work conditions, a large proportion (70%) of PwP were reviewed by a specialist nurse.

Utilization of technology in the recent past within our Hospital trust meant that remote review of PwP was possible early following hospital admission which reflects the high percentage of PwP receiving specialist input during the first wave of the COVID-19 pandemic.

Our data shows a high mortality rate in PwP (60%); High mortality rate has been observed in other studies compared to age matched controls (35%) in comparable healthcare settings in Europe. Risk of mortality was observed to be event higher in patients with atypical parkinsonian disorders.

Our data does have limitations taking to account the small study numbers.