Patient Education Resource Center
As a national leading provider of senior healthcare services, Consulate Health Care is pleased to provide patient education resources for the health conditions that are most prevalent among our elderly population. Below, you will find the topics for each of the nine educational resources. By clicking on any of these topics, you will be able to access information about the medical condition, symptoms, treatment and much more. We hope you find these resources helpful and will consider the compassionate and caring services of Consulate Health Care for all of your senior healthcare needs.
Parkinson’s Disease
Parkinson’s disease is a degenerative and progressive disorder of the nervous system that effects movement. With this disease, there is a slow deterioration of motor function due to the loss of cells that produce a substance called “Dopamine”.
Normally, Dopamine acts as a messenger between the cells of the brain that produce and control smooth and coordinated movement. Additionally, the transport of Dopamine across some brain cells influences behavior and mood.
Primary motor or “body” symptoms associated with Parkinson’s Disease
- The slowing down and loss of natural, purposeful movement called “bradykinesia”.
- Unusual stiffness or rigidity to arms, legs, trunk or facial expression.
- Uncontrollable shaking or tremors at rest that temporarily stop when you move.
- Impaired balance and coordination making safe walking difficult called “postural instability.”
Secondary motor or “body” symptoms of associated with Parkinson’s Disease
- Decrease in the ability for “automatic responses” such as blinking and effective swallowing. Drooling may occur.
- Small, overcrowded handwriting called; “micrographia”
- Low volume or muffled quality to voice called; “hypophonia”
- Increased tendency to freeze or lean backwards when walking called; “retropulsion”
- Shuffled gait from dragging feet while walking and reduced arm swing while walking.
Progressive Stages of Parkinson’s Disease (Hoehn and Yahr scale)
Symptoms primarily noticed on one side of the body.
Both sides of the body displaying symptoms, but balance is unaffected.
The individual remains independent however, balance is impaired.
Able to walk and stand unassisted however, other symptoms are creating significant disability and dependence for help with activities of daily living.
Wheelchair or bedridden. Total assistance required in all aspects of every day living. Often “Parkinson’s dementia” is noted, which can include impaired or lost functions in judgment, language, speech, memory, perception, reasoning, and mental abilities.
Risks Associated With What You Feel
Tremors at Rest / Sleeping Problems
You may not receive enough rest to meet your body requirements. You may feel drowsy during the daytime and find concentration difficult. You may find that positioning for comfort in bed is difficult. Balance and coordination may worsen as a result of sleep deprivation. Insufficient sleep may increase your likelihood of falling. Talk with your physician about the best methods and strategies to obtain the necessary rest that you require. Try to limit fluids at a certain hour to avoid waking to use the bathroom. Try to refrain from excessive daytime napping so that you retire ready for rest. Reducing disturbing noises by adding music or white noise to your bedtime surroundings and ensuring ambient darkness and pain relief modalities, may help sleep patterns.
Slowness / Stiffness and Rigidity / Poor balance / Shuffling walk
Poor balance may reduce your ability to be as independent as you would like. It may be difficult to seek assistance with the activities of daily living that you were able to perform. You may feel irritable or anxious as your disease progresses and you require more help to walk, change positions, dress, eat and drink without spilling and dropping food, bathing and using the toilet. Please seek counseling to provide you with an outlet for your frustration and help with coping strategies.
Difficulty Swallowing
You may experience difficulty eating food that is not easily chewed. Some food textures may give you trouble to ingest. In addition, you may drool or even have a dry mouth as a result of medication side effects. Eating foods that are challenging to go down, may cause you to choke or “go down the wrong pipe”. Your speech therapist can show you techniques that can help you to swallow more safely. Meeting with the dietician may help to identify risky foods beforehand to choose alternative but satisfying cuisine. As swallowing difficulties worsen, you may need to discuss your options and wishes with your loved ones and care team.
Soft Speech
Communication may become difficult as the disease progresses. The facility speech therapist may be able to assist you with both your communication challenges and the difficulty you experience with swallowing. It is best to try to talk in an area that is not noisy and in a place where you can see people’s faces easily and maintain good posture. You will be most successful if you are not tired. Try to speak slowly, using short phrases or write your message down. Use expressions and gestures to assist in making your point.
Slow Thinking and Memory Loss
You may struggle with problem solving tasks such as forming concepts and strategies, making plans, setting goals, anticipating outcomes, and evaluating progress. Paying attention may be hard for you, or finding the right word or phrase. Sometimes these thought changes can be the result of a medication side effect, while this is also a common problem with the disease itself as well. Fatigue or a vitamin deficiency such as B12 complicates thought problems. Slow thinking can also be linked to depression, apathy and anxiety. It is important to inform your doctor about these concerns.
Constipation
It is important to drink plenty of fluids during day hours. Our facility dietician can help you plan meals that will reduce constipation. Additionally, your physician may prescribe fiber supplements, stool softeners and stimulating bowel medications like laxatives. Our staff will monitor your movements and can provide remedies to keep you as comfortable as possible. Tell the nursing staff of any difficulties moving your bowels to prevent straining and appetite loss.
Physicians / PCP’s
A Primary Care Provider will follow your progress and may prescribe you medications, treatments, therapy, and order tests necessary for your care. Often, your primary care provider will work closely with a neurologist, a physician specializing in disorders of the nervous system. Additionally, your doctor may consult a psychiatrist or psychologist to assist with mental, behavioral or emotional challenges. Provisions will be available to have all of your consultants evaluate and prescribe either at the bedside, or we can assist in arranging transportation for you to visit their offices.
Clinical Staff
Nurses and nursing assistants will work together to follow your individualized plan of care and follow the medical orders prescribed by your primary care provider. They may assist and support you with activities of daily living such as eating, bathing, dressing, toileting and transferring. They may provide education and instruction to you and your loved ones as necessary. They are your primary contact source to coordinate your care. All questions, concerns or challenges should be reported promptly to our clinical staff members any time, day or night.
Social Workers
The center’s social workers provide individual, family support and assistance in coping with the stress related to Parkinson’s disease. Social Workers are an excellent resource for referral information related to community support and advanced care planning.
Physical Therapists
Licensed professionals will evaluate and treat issues related to mobility, walking, flexibility, balance, posture, strength, and endurance. Exercise is a vital component in the treatment of Parkinson’s disease. They can also provide training to your loved ones.
Occupational Therapists
Licensed professionals that will evaluate and treat through means of adaptation and modification, assisting you to be as independent as possible in activities of daily living. They will help in areas of bathing, dressing, eating, toileting, transferring and safety. They can also provide training to your loved ones.
Speech-Language Pathologists
Licensed professionals will evaluate and treat challenges related to communication, eating, safe swallowing, thinking and memory. They are helpful in providing tips for eating, phlegm management and drooling.
Dietician
The dietician can meet with you and your loved ones and assist in meal selection, preferential meal planning, and weight maintenance.
Pharmacist
Provides valuable recommendations and monitors prescription medication for safety and effective outcomes in symptom management and relief.
Parkinson’s disease can not be cured. The goal of treatment is to:
Reduce symptoms
Increase mobility
Improve life quality
Dopamine Replacement Therapy: Sinemet (Carbidopa and Levodopa combination) is the most common medication used in the treatment of Parkinson’s disease. It is a combined medication so as to reduce the incidence of nausea and vomiting, and the addition of Carbidopa, prevents Levodopa from being converted into dopamine in the bloodstream. This allows more of it to get to the brain, and results in less Levodopa needed to treat symptoms.
Dopamine Agonist Therapy: These medications stimulate the parts of the brain influenced by dopamine. In other words, the brain is tricked into thinking it is receiving the dopamine it needs. In general, dopamine agonists are not as potent as Sinemet. Dopamine agonists can be taken alone or in combination with medications containing Levodopa. The two most commonly prescribed pills are Mirapex (Pramipexole) and Requip (Ropinirole). Dopamine agonists may cause nausea, hallucinations, sedation, falls, and lightheadedness due to low blood pressure.
Anticholinergic Medication: These drugs are helpful in reducing tremors and controlling the involuntary repetitive movements interfering with the performance of day to day tasks. Examples of these medications are Arctane (Trihexyphenidyl) and Cogentin (Benztropine Mesylate) These substances do not act directly on the brain system associated with Dopamine. Instead, they decrease the activity of a chemical messenger in the brain that regulates movement called “Acetylcholine”. Potential side effects include blurred vision, dry mouth, constipation, urinary retention and confusion and/or hallucinations in older adults.
MAO-B Inhibitors Medications: Eldepryl, Zelapar (Selegiline) and Azilect (Rasagiline) are commonly used medications in this classification. These medications block an enzyme in the brain that breaks down Levodopa and has a modest effect in suppressing the symptoms associated with Parkinson’s disease. In later disease stages, these medications may be used in combination with Sinemet.
COMT Inhibitors Medications: The newest class of Parkinson medication is COMT inhibitors. These medications include Comtan ( Entacapone) and Tasmar ( Tolcapone) which are used to prolong the effects of Levadopa by blocking or slowing down Levadopa metabolism.
Other Medications: Other medications used may provide symptomatic relief such as Symmetrel (Amantadine) a mild agent that is used in early Parkinson’s disease to help reduce tremors. Symmetrol has also been found useful in reducing spontaneous involuntary movements that occur with dopamine medication. It is a is a well-tolerated drug, but its potential side effects include dry mouth, constipation, bladder problems, ankle swelling and skin rash.
Exelon (Rivastigmine) is the only medication approved by the US Food and Drug Administration for the treatment of Parkinson’s Dementia.
Examples of additional medications made be prescribed to assist with mood, constipation, sleep disorders, pain, hallucinations, insomnia and dermatitis.
Planning care when a resident has Parkinson’s disease must include methods of prevention, early detection, evaluation and treatment of the following potential complications:
- Long term Levadopa Treatment Syndrome – Occurs 2- 6 years after beginning treatment and characterized by a deduction in the effects of the medication.
- Psychiatric disturbances
- Sleep disturbances
- Depression / suicide ideation
- Confusion
- Impaired swallowing and aspiration
- Respiratory distress
- Safety – Falls are very common, choking while swallowing is a concern especially as the disease progresses
- Urinary Tract Infection
- Pain management
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