Variability from Person to Person
No two people will have identical symptoms or reactions to medications, and there is no universal "Parkinson’s care plan" to fit all Parkinsonian residents.
Variability in Symptom Control Within Each Individual
With advanced Parkinson’s neither resident nor staff can accurately predict how well that person will be able to function the next day – or the next hour. There is a need for constant assessing.
Staff must understand that when a resident is not able to perform a specific motor task, she/he is not being stubborn – for the time, the medications are not controlling the symptoms.
Challenges in Maintaining the Parkinsonians Mobility
Walking and other physical activity must continue as long as possible because these can reduce stiffness, and help control other symptoms such as constipation, depression and rigidity. At the same time, staff must realize that with advanced Parkinson’s, balance and gait are impaired and there is a real threat of falls.
Medication Management is Difficult and Critical for Parkinsonians
Timing, dosages and reactions (both positive and negative) seem to be more individualized than for other health conditions. Patients may seem overly anxious about their medications because they realize good mobility and symptom control depends upon the pills being received on time and in the proper dosages.
Challenges for Staff
- Staff may have to administer Parkinson’s medications at times different from the general medications rounds. Although this may seem like an additional burden, effective timing and dosage of medications will lead to a greater level of independence for the person with Parkinson's and therefore reduce the amount of assistance needed from Community Caregivers.
- Staff must learn to recognize psychiatric side effects of medications.
- Some major tranquilizers are contraindicated with Parkinson’s medications.
- The residence physician may find it useful to consult with a Parkinson’s specialist when medication reassessment appears advisable for optimal mobility and cognitive functioning.
- Unless there is gross cognitive impairment, the patient should be involved in medication administration.
With advanced Parkinson’s, a resident may speak with very low volume, may slur words, and be slow in responding. Staff may label the person cognitively impaired. They may "talk over the resident’s head" or not allow enough time for a real conversation.
The "masked face", lack of body language and monotone voice may lead staff to think the resident is not interested in sharing a conversation.
Parkinson’s communication problems are complicated further by changes in hearing that often accompany aging. (adapted from Parkinson Society Ottawa)
Parkinson Society Maritime Region, through our resource library have information specific to health care professionals.