Addressing critical care gaps in inpatient Parkinson's care – Minimizing the impact of comorbidities and developing new care delivery models

      As Parkinson's disease (PD) advances, degradation in neurological function increases the likelihood of complications from other illnesses. Swallowing may worsen, putting patients at risk for aspiration pneumonia; balance and mobility may worsen, putting patients at risk for falls and fractures; and cognition may worsen, increasing the risk for confusion, delirium, and psychosis. This results in increased hospitalization rates, adverse drug effects, polypharmacy, and overall poor outcomes [
      • Tenison E.
      • Henderson E.J.
      Multimorbidity and frailty: tackling complexity in Parkinson's disease.
      ]. In addition to the progressive nature of the condition, comorbid illnesses may exacerbate parkinsonian symptoms and complicate care. This interplay between the medical risk associated with PD and comorbidities is critical to understand.
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        • Tenison E.
        • Henderson E.J.
        Multimorbidity and frailty: tackling complexity in Parkinson's disease.
        J. Parkinsons Dis. 2020; 10: S85-S91
        • Gerlach O.H.H.
        • Winogrodzka A.
        • Weber W.E.J.
        Clinical problems in the hospitalized Parkinson's disease patient: systematic review.
        Mov. Disord. 2011; 26: 197-208
        • Gerlach O.H.
        • Broen M.P.
        • van Domburg P.H.
        • Vermeij A.J.
        • Weber W.E.
        Deterioration of Parkinson's disease during hospitalization: survey of 684 patients.
        BMC Neurol. 2012; 12: 13
        • Temlett J.A.
        • Thompson P.D.
        Reasons for admission to hospital for Parkinson's disease.
        Intern. Med. J. 2006; 36: 524-526
        • Klein C.
        • Prokhorov T.
        • Miniovitz A.
        • Dobronevsky E.
        • Rabey J.M.
        Admission of Parkinsonian patients to a neurological ward in a community hospital.
        J. Neural. Transm. 2009; 116: 1509-1512
        • Low V.
        • Ben-Shlomo Y.
        • Coward E.
        • Fletcher S.
        • Walker R.
        • Clarke C.E.
        Measuring the burden and mortality of hospitalisation in Parkinson's disease: a cross-sectional analysis of the English Hospital Episodes Statistics database 2009–2013, Parkinsonism Relat.
        Disord. 2015; 21: 449-454
        • Skelly R.
        • Brown L.
        • Fakis A.
        • Kimber L.
        • Downes C.
        • Lindop F.
        • Johnson C.
        • Bartliff C.
        • Bajaj N.
        Does a specialist unit improve outcomes for hospitalized patients with Parkinson's disease?.
        Park. Relat. Disord. 2014; 20: 1242-1247
        • Martinez-Ramirez D.
        • Giugni J.C.
        • Little C.S.
        • Chapman J.P.
        • Ahmed B.
        • Monari E.
        • Wagle Shukla A.
        • Hess C.W.
        • Okun M.S.
        Missing dosages and neuroleptic usage may prolong length of stay in hospitalized Parkinson's disease patients.
        PLoS One. 2015; 10e0124356
        • Hou J.G.
        • Wu L.J.
        • Moore S.
        • Ward C.
        • York M.
        • Atassi F.
        • Fincher L.
        • Nelson N.
        • Sarwar A.
        • Lai E.C.
        Assessment of appropriate medication administration for hospitalized patients with Parkinson's disease.
        Park. Relat. Disord. 2012; 18: 377-381
        • Lertxundi U.
        • Isla A.
        • Solinís M.Á.
        • Echaburu S.D.
        • Hernandez R.
        • Peral-Aguirregoitia J.
        • Medrano J.
        • García-Moncó J.C.
        Medication errors in Parkinson's disease inpatients in the Basque Country.
        Park. Relat. Disord. 2017; 36: 57-62
        • Magdalinou K.N.
        • Martin A.
        • Kessel B.
        Prescribing medications in Parkinson's disease (PD) patients during acute admissions to a District General Hospital.
        Park. Relat. Disord. 2007; 13: 539-540
        • Tanaka M.
        • Suemaru K.
        • Ikegawa Y.
        • Tabuchi N.
        • Araki H.
        Relationship between the risk of falling and drugs in an academic hospital.
        Yakugaku Zasshi. 2008; 128: 1355-1361
        • Gerlach O.H.H.
        • Broen M.P.G.
        • Weber W.E.J.
        Motor outcomes during hospitalization in Parkinson's disease patients: a prospective study.
        Park. Relat. Disord. 2013; 19: 737-741
        • Chou K.L.
        • Zamudio J.
        • Schmidt P.
        • Price C.C.
        • Parashos S.A.
        • Bloem B.R.
        • Lyons K.E.
        • Christine C.W.
        • Pahwa R.
        • Bodis-Wollner I.
        • Oertel W.H.
        • Suchowersky O.
        • Aminoff M.J.
        • Malaty I.A.
        • Friedman J.H.
        • Okun M.S.
        Hospitalization in Parkinson disease: a survey of national Parkinson foundation centers, parkinsonism relat.
        Disord. 2011; 17: 440-445
        • Mehta S.
        • Vankleunen J.P.
        • Booth R.E.
        • Lotke P.A.
        • Lonner J.H.
        Total knee arthroplasty in patients with Parkinson's disease: impact of early postoperative neurologic intervention.
        Am. J. Orthoped. 2008; 37: 513-516