Activities of Daily Living When Your Patient Has Parkinson’s...

Maintaining A Safe Env:

Try to ensure a clutter free area to reduce risk of falls or “freezing”

Try to ensure that medication is stored correctly, and then taken correctly, i.e.. right tablet at the right time

Keep walking aids within easy reach

Keep phone / call system within arms length

For home adjustments, grab rails, ramps, etc, try to enlist the help of an OT.

Communication:

People with PD can often have problems with the volume of their voice... They don’t realise that they are speaking quietly, they just assume others have hearing problems. They can also have problems due to speaking too quickly or too slowly. This is known as Dysarthria.

Encourage them to speak slowly and put stress on the important words, while trying to use a loud voice.

Don’t try to pretend that you understand if you do not... The person will know that you are lying.

Handwriting can be another problem. Often the writing becomes small and cramped and difficult to read. Offer to help making lists or writing cards or letters.

Breathing:

People with PD would not normally have issues with their breathing, although they may have an underlying condition that affects them.

However, if the person is wearing off, they may suffer from anxiety, or panic attacks, and so may have a high rate of breathing.

Eating and Drinking:

People with PD can run into difficulty with their swallow, which is known as Dysphagia.

Signs of this may be :

Food/drinking catching in their throat

Coughing or choking episodes, esp.. after drinking

Wet gurgly voice during or after meals

Weight loss, chest infections or dehydration

Tips to help:

Try to make meal times when medication is working well

Sit upright

Small mouthfuls

Avoid chatting while eating

Avoid crumbly foods (egg dry toast, biscuits)

Do not use a straw

Have cold drinks to make swallowing more efficient

It is important that if you are concerned about any of the above, that this person is reviewed by a SLT to ensure that they have a safe swallow. The person with Parkinsons may simply be given exercises to improve their technique.

For people with Parkinsons, eating can sometimes be a messy and slow process. They may wish to eat alone, or they may require aids, such as weighted cutlery or a cup with a lid.

It is essential that the person should be allowed sufficient time to eat, and enjoy their meal.

It may be necessary to provide small meals more frequently, to prevent eating cold food.

If drooling is a problem, encourage them to keep their head in an upright position. Sometimes prompting them to regular swallow their saliva can be helpful.

Elimination:

Constipation is a big problem in PD. It is often an on-going problem. However, once managed, Parkinsons medication works better, reduces confusion. Many people who have PD will require laxatives to help them.

Poor diet may also contribute to constipation. You can help by encouraging a diet with fresh fruit/veg, more fibre, and also encouraging them to increase their fluid intake.

Incontinence can be an embarrassing and distressing problem. It is important to find out why incontinence occurs and if there is any ways to combat this.

  Is the problem due to decrease mobility, or are they too slow to make it to the bathroom?

Ensure they have had their tablets to increase mobility

Try to keep route to the toilet clutter free and clear

Keep urinal or commode within reach if needed

Is the problem due to difficulty with buttons or zips?

Encourage the use of velcro fasteners or elasticated waist trousers or skirts

Washing and Dressing:

Some people will have problems with buttons and zips, so clothing alterations may be needed to improve independence.

Drenching sweats can be a common occurrence in PD, so personal hygiene is very important. These sweats can irritate the skin, causing redness, itching or waxy scaling of the skin. This greasiness is particularly common around the forehead, eyebrows and scalp.

For mouth care, the use of an electric toothbrush can be very helpful. Encourage the person with PD to use an alcohol free mouthwash to avoid drying out their mouth.

 

Temperature Control:

One of the non-motor symptoms is a sensitivity to the heat or the cold.

Sudden complaints of change in temp may be related to “wearing off”.

 

Mobility:

PD can have major impact on a person’s mobility. These problems can range from slowing up to sudden freezing to uncontrollable excess movements. These complications significantly increase their risk of falling. It is important that any exercises given by physio are continued for as long as possible.

The most common problems are:

Walking:

Give enough time, no rushing

Taking short, shuffling steps? Encourage them to take steps by putting their heel down first, and count out the steps.

Posture:

Encourage them to stand up tall and correct their posture regularly. Exercises available to aid good posture.

Standing from Sitting:

Ensure they sit in high backed, firm chairs with arm rests.

Again, please allow enough time.

Turning around:

Encourage them to walk in a wide circle to turn around, as pivoting can be very difficult.

 

Turning in bed:

They may require your help turning overnight. Or they may need a bedrail or simply advice and encouragement.

Ensuring that medication is taken correctly at bedtime can help with night-time wakening due to discomfort. Likewise, if they require rescue medication overnight, ensure it is within reach.

Freezing: **This can occur at ANY time**

It may be useful to use cues to help out in freezing situations, such as counting out loud. Another tip may be to place your foot in front of theirs, or use a laser light and tell them to “step over” it.

Don’t try to pull them along, this will only result in a fall.

Work and Play:

It is essential that people with PD are encouraged to continue with their usual activities, such as gardening, or doing the shopping, so long as they are happy to do so. There is no reason that the social aspects of their lives need to be affected.

Promote an interest away from the daily presence of PD

Revive personality and promote independence

Sexuality:

Some people can display inappropriate sexual behaviour. This can be related to their medication, but it still needs to be addressed as soon as possible as there may be other underlying Impulsive Behaviours. These behaviours, if caused by their medication can be successfully treated by reducing or stopping the offending medication.

Sleep:

People with Parkinsons can often have trouble with sleep. This can be cause by:

Pain – dystonia

Discomfort – wearing off

Toilet – need to use the toilet 5-6 times/night

Restless Legs

Can often be rectified with additional or new medication.

Death and Dying:

Parkinson’s disease does not cause death. It can be a contributing factor to getting a bad pneumonia (bad posture or swallowing difficulties).

A diagnosis of PD often evokes fear of death or ending up in a wheelchair. Please try to allay these fears, people with PD can lead healthy normal lives for a long time.

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