APDA American Parkinson Disease Association
Information & Referral Center

Hospitalization and PD

Most people will need to be hospitalized for one reason or another at some point in their life. This is particularly true of people with long-term illnesses, like Parkinson’s Disease (PD). Common reasons for hospital admissions from the emergency room can include infections of the urinary tract or lung (such as pneumonia), cardiac issues, injury from falls, and cognitive or dementia issues. Common reasons for non-emergency hospitalizations are elective surgeries such as knee and hip replacements.

Hospitalization can be devastating for PD patients and tremendously stressful for their caregivers for a number of reasons:

It is important for the patient and the caregiver to plan and to anticipate what is likely to happen. The combination of education and planning can alleviate many of the problems encountered in the hospital.

Here are some resources that are specific to the issues of hospitalization and PD:

Best Publications

"Aware in Care, Hospital Action Plan"
National Parkinson's Foundation, 2012
This 22-page booklet summarizes the need for advocacy during hospitalization for people with Parkinson's Disease. It outlines specific steps to prepare for a hospitalization and encourages readers to be prepared in advance of the unknown, much like we have earthquake kits. It advises calling upon the hospital's patient advocate if the patient is not getting proper care.

"When Should Parkinson's Disease Patients Go To The Emergency Room?" by Joseph H. Friedman, MD
American Parkinson Disease Association, 2007
This three-page educational supplement notes that the emergency room works best for infections, broken bones, blood clots, and the like, but they are ill-equipped to handle Parkinson's Disease because ER doctors are not trained to know much about it. Several scenarios describe how an ER visit for a person with Parkinson's Disease can go horribly wrong, and why.

Best Online Video

"Hospitalization: An Action Plan to be Aware in Care" by Michael Okun, MD and Anhar Hassan, MD
National Parkinson Foundation webinar, April 5, 2012
Recording of audio and slides
Presentation (presenters' slides)
In this 45-minute webinar, the two neurologists discuss the results of studies showing how poorly people with Parkinson's fare during hospitalizations. They explain the possible causes of such dismal outcomes and introduce the Aware In Care Kit and how to use it to advocate for a person with Parkinson's in the hospital.

Best Resource Kit

Aware In Care Kit
Offered at no charge by National Parkinson Foundation. Order online or by calling NPF tollfree 800/473-4636.
The kit is a shoulder bag for medications needed during a hospital stay; a Hospital Action Plan booklet that helps you prepare for hospitalizations, planned or unexpected; a PD ID bracelet; a medical alert wallet card; a medication list; a PD fact sheet that can be shared with hospital staff or placed in a chart, etc.

Expert-Level Reading

"Deterioration of Parkinson's Disease During Hospitalization: Survey of 684 Patients" by Oliver HH Gerlach, Martijn PG Broen, Peter MNF vanDomburg, Ad J Vermeij, Wim EJ Weber, BioMed Central Neurology, 2012.
In this Dutch study, Parkinson's patients answered a standarized questionnaire on general, disease, and hospital related issues. 684 PD patients had been hospitalized at least once in the last year. Regardless of the type of admissions ward and whether or not the patients had surgery, incorrect medication during hospitalization was the most important risk factor for deterioration.

"How Should Parkinson's Disease be Managed Perioperatively?"
by Swati G. Patel, MD, Chad R. Stickrath, MD, Mel Anderson, MD, and Olga Klepitskaya, MD, The Hospitalist, June 2010.
This literature review of potential hospitalization risks in PD patients includes a discussion of techniques that may be uniquely required in the Parkinson's population. The authors note that other conditions, like cariodpulmonary disorders, already receive a great deal of attention with regard to perioperative risk assessment and PD deserves a similar level of attention.

"Management of the Hospitalized Patient with Parkinson's Disease: Current State of the Field and Need for Guidelines" by Michael J. Aminoff, et.al. for the National Parkinson Foundation Working Group on Hospitalization in Parkinson's Disease, Parkinsonism & Related Disorders, March 2011; 17(3): 139–145.
This literature review identifies practice gaps in the management of the hospitalized PD patient. Medications, dosages and specific dosage schedules are critical. Staff training regarding medications and medication management may help avoid complictions, particularly those related to reduced mobility, and aspiration pneumonia. Treatment of infections and return to early mobility is also critical to management.

"Medication Management in People with Parkinson's Disease During Surgical Admissions" by C.P. Derry, K.J. Shah, L. Cale, and C.E. Counsell, Postgraduate Medical Journal, 2010.
In an 18-month study done at the Aberdeen Royal infirmary, UK, medical and nursing notes for PD patients admitted to surgical departments were reviewed retrospectively. Researchers found poor prescribing and incomplete drug administration were common. Measures to improve medication management are identified.

 

 

This list compiled by Denise Dagan with the Stanford APDA Information & Referral Center, May 2012.

 

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