Long-Term Care

Parkinson's disease

LTC Nursing Assistant Trainer, December 1, 2004

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Parkinson's disease is a slowly progressive neurological disease that results in problems with movement. The disease advances at a different rate for each person. Some people may experience little disability after twenty years, while others may be completely disabled after ten years. Eventually, most Parkinson's sufferers will die from the complications of immobility.

There are no laboratory or blood tests to diagnose Parkinson's disease. Physicians diagnose the disease by observing symptoms over time, ruling out other diseases, and noting whether the patient responds positively to drugs used to treat the disease.

Not all patients have all symptoms of Parkinson's disease. There are myriad variations in how and at what rate the symptoms progress. Here are some common symptoms of the disease, ranging from the mildest to most severe, and nursing care suggestions for each.

  • Tremor

    The first symptom of Parkinson's disease is usually tremor. The tremor is characterized by a rhythmic back-and-forth movement of the thumb and forefinger, sometimes called pill rolling.

    • Give your residents with hand tremors something to hold. When tremor is in its early stages, just holding something in the hand can still the tremor.

  • Rigidity

    Rigidity of the entire body and neck affects most Parkinson's residents and becomes more severe as time passes. Rigidity makes walking and other activities of daily living increasingly difficult. The muscles remain constantly tense and contracted-resulting in aching, weakness, and stiffness.

    • Warm compresses, massage, and exercise help relieve muscle tension and discomfort.

  • Bradykinesia

    The resident's ease of movement slows as the disease progresses. This slowed movement is entirely unpredictable-the resident may move easily one moment and need help the next. Activities that were once routine and done quickly-such as bathing or brushing one's teeth-may now take hours.

    • Encourage the resident to continually practice brushing the teeth, combing the hair, bathing, etc. Constant repetition of activities can help the resident retain the ability to perform simple tasks. To help the resident maintain the highest level of independence, offer only the degree of assistance that is required at the time.

  • Walking

    Early in the disease, Parkinson's residents may drag their legs slightly and show a decrease in arm swing when walking. Later, they usually develop a stooped posture in which the head is bowed and the shoulders droop. They walk with a series of quick, small steps. Eventually, even with assistance, most Parkinson's sufferers completely lose their ability to walk.

    Here are some suggestions for helping a Parkinson's resident walk more smoothly and prevent falls:

    • Tell him or her to swing the arms as freely as possible. This helps take the weight of the body off of the legs.
    • Suggest that, when the resident is walking or turning, he or she spread the legs about ten inches apart to provide a wider base for better balance and steadier movement.
    • Suggest that he or she take small steps when making turns to avoid a fall.
    • If the body leans to one side, tell him or her to carry something with weight in the hand of the non-leaning side to help maintain balance.

  • Freezing

    One of the most noticeable symptoms of Parkinson's disease is the tendency to freeze in place. This most often happens when there is a perceived barrier, such as a doorway or a change in color or material on the ground or floor.

    • Suggest the person lift the toes or rock slightly to restart movement.

  • Speech

    Parkinson's residents usually develop speech problems, such as softness of voice, speaking in a monotone, hesitation, or slurred speech. Early problems can be helped by speech therapy, but, the resident's speech will probably eventually become unintelligible.

    • Make every effort to understand what the resident is trying to say to you. Be patient while he or she searches for words, stutters, or slurs. Losing the ability to speak is extremely stressful.

  • Salivation

    Parkinson's disease causes an increase in the production of saliva. Early in the disease, the resident will drool at night-eventually, there is significant drooling during the day.

    • This is embarrassing, so provide him or her with tissues or cloths to wipe the mouth, if able, or wipe the mouth for the resident.

  • Eating & swallowing

    Eating, at first, may take more time and effort. Utensils are difficult to handle and most residents will need help cutting food. As the disease progresses, the resident will choke often while trying to swallow food. At some point, most residents will need a soft food diet and/or tube feeding.

    • Help with cutting food while a resident is still able to feed himself or herself. When handling a utensil becomes too difficult, you will need to feed him or her.

  • Intellectual & emotional capacity

    One of the early signs that Parkinson's is affecting a person's intellectual capacity is frequent forgetfulness. Over time, memory loss and signs of disorientation increase. Depression, apathy, and irritability may be present. With time, the resident will become less and less able to understand complex problems and ideas. Some medications used to treat Parkinson's disease can increase depression.

    • Make sure to notify your supervisor of signs of depression, which can be effectively treated with anti-depressant medications.

As you can see, there are many issues associated with Parkinson's disease. However, improved medications and other treatments are helping people remain independent for extended periods of time.



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