Neurologists have key end-of-life role for Parkinson’s patients
medwireNews: Around a quarter of patients with Parkinson’s disease (PD) end up in a long-term care facility or nursing home, say researchers who highlight the role of neurologists in improving these patients’ care.
The study was US-based and involved 469,055 Medicare recipients who had PD, of whom 113,668 (24%) were living in a long-term care facility or nursing home at the time of the study.
“Given the early clinical responsiveness of PD, it is natural to overlook some harsh facts: we are managing a chronic and progressive condition for which palliative care begins at the first consultation, with a large proportion of patients with PD destined to reside in nursing homes”, write John Worthington (The University of New South Wales, Sydney, Australia) and John Ney (University of Washington, Seattle, USA) in an editorial accompanying the study.
Patients in long-term care were more likely to be women and of Black race than those who were community-based, and were more likely to have comorbid diagnoses, report Allison Willis (University of Pennsylvania Perelman School of Medicine, Philadelphia, USA) and study co-authors in Neurology.
Dementia and hip fracture were the comorbidities most strongly associated with being in long-term care, increasing this likelihood around fourfold and twofold, respectively. Dementia was also the most frequent comorbidity, occurring in 65.9% of the PD patients in long-term care.
Of the approximately 85% of patients in long-term care who died during the study, 54.2% did so in a hospice, and the likelihood of receiving hospice care was increased 2.35-fold in long-term care patients who had also been seeing a neurologist on an outpatient basis. This association persisted after accounting for confounders, with 80.7% of neurologist-treated patients receiving hospice care, compared with 59.8% of other patients.
These findings “suggest that tens of thousands of patients with PD would benefit from [hospice] care and from improved access to neurologists toward the end of their disease”, observe Worthington and Ney, although they caution that the study design cannot definitively prove that neurologist consultation resulted in better end-of-life care.
“Nonetheless, this report highlights an important role for neurologists at a stage when transport of patients with PD may be less feasible and when changes in specific PD treatment may seem futile”, they write.
“Perhaps increased neurologist awareness of their efficacy in the nursing home setting and emerging use of telemedicine will facilitate better end-of-life care for people with PD.”
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