Authors (including presenting author) :
Cheng JN (1), Ip CY (1), Fung C (1), Tsang YL (2), Lee ML (3), Leung CS (1)
Affiliation :
(1) Department of Medicine and Geriatrics, Caritas Medical Centre (2) Department of Physiotherapy, Caritas Medical Centre (3) Department of Occupational Therapy, Caritas Medical Centre
Introduction :
Parkinson’s disease (PD) is an insidious and slowly progressive neurodegenerative disease which is more prevalent in the elderly. A local survey done in 2004 revealed that the prevalence rate of PD was 188 per 100 000 in the Hong Kong Chinese population in the community . An earlier local study done in 1989 showed that the prevalence of PD among residents of homes for the elderly was even higher, of 3.4% . PD is characterized with both motor and non-motor symptoms, which could be difficult to control as they are often complicated. These patients require more medical attention and they need both pharmacological and non-pharmacological interventions. Thus, a multidisciplinary approach in managing patients with PD would give the greatest benefits.
In Caritas Medical Center, there is Parkinson’s disease clinic. However, due to the manpower issues, it is just a single discipline clinic run by geriatricians. Meanwhile, Geriatric Day Hospital (GDH) has a multidisciplinary team, with geriatricians, nurses, physiotherapists and occupational therapists working together. Comprehensive Geriatric Assessment and interventions can be easily carried out, and case conferences are held regularly to discuss patients’ progress. Thus, GDH can be a suitable place for managing patients with PD who are in need of comprehensive care, medications adjustment, mobility and functional training, home modifications and carer education.
Objectives :
1. To enhance the medical care to patients with PD, to alleviate their motor and non-motor symptoms
2. To provide mobility and functional training to patients with PD, so as to prevent fall and improve their activity of daily living
3. To support patients and their caregivers in terms of their stress towards the disease
The following groups of patients with Parkinson's disease were targeted to the program:
1. who have unsatisfactory control of motor or non-motor symptoms, requiring frequent medications adjustment and medical attention.
2. who experience falls, requiring Multidisciplinary Multifactorial Fall Assessment.
3. who have stress about their disease, and it affects their activity of daily living
4. who require comprehensive geriatric assessment, mobility and functional training
Methodology :
After the patient is recruited to the program, geriatricians will offer Comprehensive Geriatric Assessment for them. Detailed medication reviews will be done, with medications adjustment when necessary targeting for symptoms control. Nurses will explore the medication adherence of patients and help them document the Parkinson’s Disease Diary, which records patient’s medication intake time and their symptoms control within a day. They will also explore the psychological symptoms of patients and their social needs, refer to the relevant disciplines when necessary. Physiotherapists will offer mobility training and walking aids when appropriate. Occupational therapists will enhance the function of patients by functional limbs & ADL training, aids prescription and carer education. Fall prevention education and home modifications will be done as indicated as well.
The routine assessment scores used in GDH will be continued. The Unified Parkinson’s Disease Rating Scale (UPDRS) will be done by different disciplines. UPDRS has 42 items, which scored from to 4, aims to assess patient’s mental status, activities of daily living, motor function, and complications of therapy. UPDRS will be done at the first and last visit at GDH for comparison.
Result & Outcome :
There were a total of 21 patients recruited to this program since November 2017. The average age of the patients were 77, 5 of them were female. The questionnaire, which was collected from patients upon completion of the training, revealed that 90% of them were very satisfied with the program, meanwhile 85% of them found their diseases better controlled. The median UPDRS of the patients significantly reduced from 48.5 to 41 (Z =-2.006, p = 0.045) after the training, indicating improvement of the symptoms of Parkinson’s disease. The median Berg Balance Scale significantly increased from 32.5 to 36 (Z =-2.334, p = 0.02), indicating improvement of balance. The median barthel Index significantly increased from 79.5 to 84.5 (Z =-2.1, p = 0.036), indicating improvement of activities of daily living. This set a good example for establishing training program based on a specific disease in Geriatric Day Hospital.
