BMC Neurol. 2012 Mar 8;12(1):13. [Epub ahead of print]
Gerlach OH, Broen MP, van Domburg PH, Vermeij AJ, Weber WE.
BACKGROUND:
A
substantial fraction of Parkinson's disease patients deteriorate during
hospitalisation, but the precise proportion and the reasons why have
not been studied systematically and the focus has been on surgical
wards and on Accident & Emergency departments. We assessed the
prevalence and risk factors of deterioration of Parkinson's disease
symptoms during hospitalization, including all wards.
METHODS:
We
invited Parkinson's disease patients from three neurology departments
in The Netherlands to answer a standardised questionnaire on general,
disease and hospital related issues. Patients who had been hospitalized
in the previous year were included and analysed. Possible risk factors
for Parkinson's disease deterioration were identified. Proportions were
analysed using the Chi-Square test and a logistic regression analysis
was performed.
RESULTS:
Eighteen percent of 684
Parkinson's disease patients had been hospitalized at least once in the
last year. Twenty-one percent experienced deterioration of motor
symptoms, 33% did have one or more complications and 26% had received
incorrect anti-Parkinson's medication. There were no statistically
significant differences for these variables between admissions on
neurologic or non-neurologic wards and between having surgery or not.
Incorrect medication during hospitalization was significantly
associated with higher risk (OR 5.8, CI 2.5-13.7) of deterioration, as
were having infections (OR 6.7 CI 1.8-24.7). A higher levodopa
equivalent dose per day was a significant risk factor for
deterioration. When adjusting for different variables, wrong medication
distribution was the most important risk factor for deterioration.
CONCLUSIONS:
Incorrect
medication and infections are the important risk factors for
deterioration of Parkinson's disease patients both for admissions with
and without surgery and both for admissions on neurologic and
non-neurologic wards. Measures should be taken to improve care and
incorporated in guidelines.
This is something I feel strongly about. Neurologists and neurology specialist registrars are often asked to see patients with Parkinson's disease who have been admitted to hospital and control of their disease has deteriorated as an inpatient. Often admission can be avoided if these risks are recognised and if the service is supported by Parkinson's disease Nurse Specialists who can arrange to see the patient in the community at short notice.
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