Co-morbidity in older people with Parkinson's disease in a long-term residence

Abstract

INTRODUCTION: Parkinson's Disease is a common disabling neurodegenerative disorder, the incidence of which increases with age. Motor features of the disorder include tremor, rigidity, bradykinesia, postural instability, gait abnormalities and problems with swallowing and speech. Non-motor features of Parkinson's Disease include dementia, depression and sleep disturbances. Despite the high prevelance of Parkinson's Disease in older people, little information is available regarding the clinical characteristics of the disease in older people in long-term care facilities. This study aimed to determine whether older people with Parkinson's Disease in St. Vincent de Paul Residence, which is the largest long-term facility in Malta, had a higher rate of morbidity than older people who did not have the condition. METHODOLOGY: The study was a retrospective, descriptive, comparative study. Older people on anti-parkinsonian treatment were the subjects of the study, and these were compared to other older people who were not on such treatment and so were presumed not to have Parkinson's Disease and who were in similar age groups, were of the same gender, and had the same duration of stay within the residence. Data was collected by assessment of the older people and by recording observations from the medical case notes. A number of instruments were used to measure various aspects of the older people's physical and mental well being. RESULTS: The proportion of older people on antiparkinsonian treatment within St. Vincent de Paul Residence was found to be 7.7%. The mean age of females with Parkinson's Disease was 79.7 years while that of males was 77.8 years. The male to female ratio was 1: 1.36. 37% of the older people with Parkinson's Disease were in the advanced stages of their disease and thus were dependent. On the other hand, 63% were still ADL independent. Older people with Parkinson's Disease were less mobile and had more fall events during the year previous to the study, than the comparison population. Bowel motions assessment showed that older people with Parkinson's Disease tended to have more episodes of impaction than the comparison population. Older people with Parkinson's Disease were more functionally impaired and had a poorer quality of life than the comparison population. Older people with Parkinson's Disease were more cognitively impaired than those in the comparison population. As regards depression, the difference between scores obtained by the study population and the comparison population was not statistically significant. The prevalence of depression was noted to increase with increasing length of stay for both groups. Complications such as pressure ulceration and sleep problems were found to be similar in both groups. In older people with Parkinson's Disease visual hallucinations, limb contractures and pain were more commonly observed. The presence of other specific coexistent medical conditions was also assessed in the study and the comparison population. The difference in the prevalence of diabetes mellitus, heart disease, cerebrovascular disease and osteoarthritis between older people with Parkinson's Disease and the comparison population was not found to reach statistical significance. CONCLUSIONS: This study has highlighted the fact that more than half of the older people with Parkinson's Disease within St. Vincent de Paul were admitted into long-term care despite being still ADL independent, while over one-third were in the advanced stages of their disease. Older people with Parkinson's Disease had a higher occurrence of complications but not of other coexistent medical conditions, than the older people who did not have this condition.