Despite Medicare data showing that about 25% of people with Parkinson’s disease (PD) reside in nursing homes, many practitioners may not have a lot of experience with diagnosing and managing this condition. As Nora Reznickova, MD, a geriatrician at Colorado Permanente Medical Group in Boulder, said, “Starting with the differential diagnosis, practitioners aren’t necessarily comfortable managing PD patients. They may not feel like they have the necessary skills and experience, and they worry that they’ll miss more atypical Parkinsonian disorders.” Dr. Reznickova and others in AMDA – The Society for Post-Acute and Long-Term Care Medicine worked on a new PD pocket guide to help boost practitioners’ confidence in addressing this condition.
Essential to effective PD treatment are: understanding all the manifestations of the disease; recognizing the importance of basic, competent primary nursing and medical care; understanding the roles of various disciplines, therapies, and specialties; and adopting the concept of realistic goal setting for each patient. “The pocket guide includes some tools to help with difficult issues related to PD, such as assessing not only motor symptoms but nonmotor ones which are frequently overlooked,” said Dr. Reznickova.
The pocket guide also gives some tips about how to address PD during routine visits, Dr. Reznickova noted. This is significant partly because PD patients have tremendous palliative care needs, she stressed. “In the guide, we mention a study in which the authors looked at the palliative care needs of PD patients and found that they were similar to or higher than people with advanced cancer.” Having these palliative care conversations is important, and the guide helps make them easier, less stressful, and more productive. At the same time, Dr. Reznickova indicated, conversations about PD in general can be painful. “There is no cure, and that is difficult for people to hear. However, there are treatments that can significantly improve quality of life, and we can talk about those. For instance, I always encourage people to start exercising as intensively as they are capable.”
Communication with staff is another challenge the guide addresses. As David Smith, MD, CMD, president of Geriatric Consultants in Brownwood, TX, observed, “One of the greatest challenges for physicians (and advanced practice providers), from my own experience, is that nursing and CNA [certified nursing assistant] staff may not recognize condition changes caused by PD’s progression. Without this information, prescribers are often unable to make those earlier interventions.” To address this, the pocket guide includes an integral history that nursing and CNA staff can collaborate on before the prescriber comes to the facility.
There is an information overload right now, Dr. Smith observed; although COVID-19 demands top priority, that doesn’t mean everything else went on vacation. “We need to be increasingly efficient and find new ways to identify problems and fix them. That is a tall order, but we can’t put this off until after the pandemic,” he said. PD is one area that needs attention, and the new pocket guide can help. He said, “Parkinson’s can progress over time. There are issues that are urgent and will come to the forefront, such as PD-related psychosis, and these will need prompt action and attention.” However, it’s important to be able to identify subtle changes as well. “The pocket guide will give people the resources they need to identity and address those subtle changes, as well as the more obvious signs and symptoms,” Dr. Smith noted. He added, “The guide is like an auxiliary brain” for practitioners and their teams.
The pocket guide is available in a package with the Society’s clinical practice guideline (CPG) on Parkinson’s disease. For more information or to order, go to https://paltc.org/product-store/parkinsons-disease-cpg-parkinsons-disease-psychosis-pocket-guide. The CPG and pocket guide are available in both paper and digital versions.
Senior contributing writer Joanne Kaldy is a freelance writer in New Orleans, LA. and a communications consultant for the Society and other organizations.