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Parkinson’s Disease

Parkinson’s Disease. Incidence. 2:1000 1:10 nursing home residents 1.7 <50yrs of age. Parkinson’s disease is …. Progressive, disabling and distressing Appropriate management and planning right from the start can prevent some of the most distressing features

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Parkinson’s Disease

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  1. Parkinson’s Disease

  2. Incidence • 2:1000 • 1:10 nursing home residents • 1.7 <50yrs of age

  3. Parkinson’s disease is …. • Progressive, disabling and distressing • Appropriate management and planning right from the start can prevent some of the most distressing features • Teamwork can address and solve most of the issues and help the GP to deliver better care

  4. Clinical features • Slowness • Stiffness • Tremor • Loss of balance

  5. What to do • Tell patient your suspicion of Parkinsonism and need for confirmation by referral • Obtain patients perspective… • What do they understand and what would they like to ask? • Check for drugs with extra-pyramidal side effects e.g. prochlorperazine

  6. What not to do • Don’t prescribe… delay until after care plan has been agreed by specialist

  7. Management • Diagnosis • Maintenance • Complex • palliative

  8. Diagnosis • Primary care team priorities: management of co-moribities, nursing assessment to address queries, carer support • Patient concerns: driving (must inform DVLA and insurers), ?genetic predisposition • Referral for confirmation of diagnosis to an physician with a special intererest in Parkinson’s disease, planning appropriate management, nurse specialist assessment

  9. Diagnosis contd Nurse specialist to act as liaison between primary and secondary care and as point of contact for the patient and carer • Refer to Parkinson’s Disease Society

  10. Maintenance • PCT priorities: watch out for complications, establish relationship with nurse specialist, care for the carer, define follow up arrangements • Aims: morbidity relief and maintenance of good health • Patient concerns: finance, work, benefits, sexual and personal relationships

  11. Maintenance contd. • Referrals e.g. to OT, physio, psychologist, social services etc.

  12. Complex • PCT priorities: support for patients and carers, look out for complications, several drugs may have to be co-prescribed • Aims: maintenance of good health, management of drugs, ensure patients and carers understand what’s going on • Referral: increased role of secondary care support, good communication

  13. Palliative • PCT priorities: consider dopa reduction or withdrawal, watch out for complications, care for the carer • Aims: relief of symptoms, pain relief, ensure patient’s dignity • Referral: palliative care services may be required, social services, ?transfer to hospice etc

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