Crawford Care Management

Parkinson's Disease

Approximately one million Americans suffer from Parkinson's Disease. The condition is characterized by the gradual deterioration of brain cells that produce dopamine, a chemical necessary for muscle control. In Parkinson's Disease, these dopamine-producing nerve cells break down, dopamine levels drop, and the brain signals directing movement become abnormal. The cause of Parkinson's Disease is unknown.

The classic symptoms of Parkinson's Disease are shaking (tremor), stiff muscles (rigidity), and slow movement (bradykinesia). A person with advanced Parkinson's Disease may also have stooped posture, a fixed facial expression, speech problems, and problems with balance or walking, as well as a decline in intellect.

Tremor is usually the first symptom people notice. Unlike most other tremors, the "resting" tremor of Parkinson's Disease is most severe when the person is awake but not moving around. The tremor improves with purposeful movement or when the person is completely relaxed or asleep. In contrast, tremors caused by other conditions typically get worse during movement and improve when the person is at rest. Many people who have tremor do not have Parkinson's Disease and up to 25% of people with Parkinson's Disease do not have tremor.

While there is no known cause or cure for Parkinson's Disease, treatments are available to improve functioning, minimize symptoms, and maintain quality of life. Drugs can help increase or produce dopamine, improve the effectiveness of dopamine, or address other symptoms, resulting in decreased tremors and muscle rigidity. Exercise is also important in optimizing body strength and flexibility. Speech therapy may be valuable in improving speech and swallowing abilities. And proper nutrition is also important in maintaining strength and function. Some patients, in advanced stages of the disease, may be candidates for specialized brain surgery to help relieve symptoms.

Education is critical to both patients' and caregivers' understanding about the course of the disease and its progressive nature. Parkinson's Disease patients are confronted with increasing difficulties over time. Everyday tasks become harder to accomplish, take longer to finish, or become impossible to do at all. Suboptimal nutrition, inadequate rest, and lack of exercise can worsen the condition. Rigid posture and uncontrolled tremors may lead to weight loss, pain, or falls. Confusion resulting from fatigue or the side effects from medications may cause patients to feel hopeless and helpless.

Those who care for Parkinson's sufferers also face growing challenges. Patience and empathy are immensely valuable qualities. Caregivers should understand that, although patients need assistance, this need contradicts the innate desire for independence. Most of us would like to "do for ourselves" for as long as we can. Accordingly, there are a myriad of ways that caregivers can provide assistance for Parkinson's sufferers that might improve their quality of life. Here are some tips:

  • Ensure that medications will be administered as prescribed and on time. This will increase the effectiveness of the drugs, and help control the symptoms.
  • Document the effects of medications on the patient's symptoms and communicate with their physician, who may need to change meds or modify dosages. Focus on the severity of tremors, changes in balance, or the presence of side effects such as nausea, heartburn, or other sources of discomfort.
  • Monitor fluid intake to help avoid dehydration. Be alert for possible signs of dehydration, including thirst, dry mouth and lips, infrequent urination, sunken eyes, cold hands and feet, or lack of energy.
  • Arrange activities during the day, when the person you are caring for is feeling their best. Try to keep up a regular bedtime routine. These steps will help avoid unscheduled afternoon naps and contribute toward a good night's sleep.
  • Remove clutter such as throw rugs, or stacks of papers or magazines that may cause injury or falls. Remove doorway sills and any barriers that would make trips to the bathroom more challenging than necessary.
  • Provide assistance with bathing to help prevent falls, to keep oily skin clean, and to wash parts of the body that may be difficult to reach. Non-slip mats, a bathtub bench, and support bars in the shower may also be helpful.
  • Assist as needed with dressing, grooming, and eating as symptoms worsen. Interventions may include:
    • Dressing in a seated position;
    • Using Velcro fasteners instead of buttons;
    • Wearing slip on shoes (smooth, flat soles are preferable to athletic shoes);
    • Cordless shavers and electric toothbrushes can sometimes be more effective;
    • Provide eating utensils with larger handles that may be easier to grasp; and
    • Encourage more frequent, but smaller, meals to aid nutrition and intake for those who are slower and who take longer to ingest food.
  • Exercise is important and walking is a good exercise. Again, make sure barriers are removed from the environment and provide support (an arm, walker, or cane) when necessary. Allow extra time and provide assistance when you are comfortable that help is desired.
  • Be patient and use great care in listening (with your ears and your eyes) as Parkinson's patients' speech may be slurred and they may speak with a soft voice. Encourage people to speak louder, exercising all muscles - from chest to mouth - that are used in the process.
  • Tune into how the person receiving care is feeling, particularly whether they are feeling anxious or depressed. Communicate concerns to the treating physician.
  • Above all, be respectful of the person you are caring for, their dignity, and their needs for independence and quality of life.