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Does Your Direct Care Staff Know the Five Stages of Parkinson's Disease?

At most assisted living facilities, personal care attendants and other direct care staff are typically offered monthly, hour-long in-service training sessions on topics that directly concern their scope of responsibility for documentation and resident safety. Discussions on specific resident health conditions, such as Parkinson's disease (PD), can often be overlooked. This can be a tragic missed opportunity, particularly because this staff may be the only health care professionals at hand that residents depend on when a crisis, such as a choking episode or fall caused by complications of PD, strikes.

According to the National Parkinson Foundation, PD is a neurodegenerative brain disorder that progresses slowly and primarily afflicts people over the age of 50. Medication is the primary treatment for PD. While there is no known cure for PD, the disease itself is not fatal. However, complications become increasingly serious over time. The Centers for Disease Control and Prevention (CDC) rates complications from PD as the 14th leading cause of death in the United States.

PD occurs when a person's brain slowly stops producing a neurotransmitter called dopamine. With less and less dopamine, the resident will exhibit a decreased ability to regulate his or her movements, body and emotions. Symptoms include involuntary shaking of limbs, called tremor; problems with balance; stiffening of muscles; difficulty swallowing; inability to use facial expressions to support feelings or to speak clearly and/or quickly; and drooling. All of these can lead to depression and/or anxiety.

Theories indicate that non-motor symptoms, such as loss of smell, sleep disorders and constipation, may precede the motor features of the disease by several years. Once a diagnosis is made, symptoms may vary from person to person and progression can take up to 20 years. Typically, there are five distinct stages of PD. These stages are defined by the following symptoms noted in the chart below.

Five Stages of Parkinson's Disease

1 Tremor and other movement-related symptoms occur on one side of the body only. There may also be noticeable changes in posture, walking and facial expressions.
2 The symptoms start getting worse, as tremor, rigidity and other movement-related symptoms affect both sides of the body. Walking problems and poor posture may become apparent. Completing daily tasks becomes more difficult and may take longer.
3 Loss of balance and slowness of movements are hallmarks of this phase. Falls are more common, and symptoms significantly impair Activities of Daily Living (ADLs), such as dressing and eating.
4 Symptoms are severe and very limiting. It's possible to stand without assistance, but movement may require a walker. The resident will likely need help with ADLs.
5 This is the most advanced and debilitating stage of PD. Stiffness in the legs may make it impossible to stand or walk. The person requires a wheelchair or is bedridden. Around-the-clock care is required of all activities and the resident may experience hallucinations and delusions.
SOURCE: National Parkinson Foundation

When dealing with a resident who has PD, the caregiver should strive to reduce the impact of the symptoms and allow the resident to function as normally as possible. The following chart offers ways to do that.

How to Assist Residents Based on their PD Symptoms

Stiff limbs and exhaustion
  • Encourage and assist with physical and occupational therapy exercises such as walking when able.

  • Provide assistive devices, such as a walker or cane, when transferring from a chair and as needed.

  • Provide periods of rest throughout the day.

Swallowing difficulties
  • Encourage the resident to eat very small bites and to chew food thoroughly before swallowing.

  • Provide foods that are soft and/or moist, such as pudding and fruits with high water content.

  • Serve thickened liquids such as milkshakes or juices in gelatin form.

  • Avoid serving foods with crumbs, such as crackers or cake, that could get caught in the resident's throat.

  • Follow speech therapy recommendations as indicated.

Falls
  • Ensure pathways are clutter- and barrier-free.

  • Provide nonslip shoes that are lightweight and fit well.

  • Provide adaptive equipment and assistance as needed.

  • Encourage and assist with physical therapy and balance-strengthening exercises.

Communication difficulties
  • Speak slowly and clearly with short sentences.

  • Be sensitive to the tone of your voice.

  • Be patient and allow time for the resident to respond.

  • Choose times when the medications are working to have important conversations.

Drooling
  • Provide tissues and assist with care as needed.

  • Avoid serving sugary foods that increase saliva.

  • Ensure dentures fit properly, when applicable.

  • Encourage and assist with proper body and head alignment for proper swallowing.

Drepression and anxiety
  • Encourage activities that provide physical and social interactions.

  • Provide relaxation techniques to ease anxiety as needed.

  • Seek professional help as needed.

Since Parkinson's is a progressive, deteriorating disease, changes can be subtle and occur over time. Alert the Nurse Manager and family when changes are observed and provide care and support as needed.

 
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