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Can we improve the inpatient care of those with Parkinson's disease?
  1. Shona Donaldson
  1. Correspondence to Dr Shona Donaldson, Associate Specialist, Care of the Elderly, Dumfries and Galloway Royal Infirmary, Bankend Road, Dumfries DG1 4AP, UK; s.donaldson{at}nhs.net

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Parkinson's disease (PD) is a degenerative neurological condition, in which the course of the disease varies in each patient. Management is tailored to the individual, hence the emergence of specialists in the care of this group. Both care of the elderly physicians and neurologists run movement disorder clinics, ably assisted by PD nurse specialists. As with most conditions where specialists are involved, other clinicians can become deskilled and unaware of the difficulties in managing patients with PD.

Medication for patients with PD requires fine tuning, especially in the later stages of the disease, to prevent and control the complications of both the disease and the treatment. These are many and varied, including ‘on/off phenomenon’, drugs ‘wearing off’, dyskinesias and psychiatric symptoms. Drug regimens can vary from once a day to once every 2–3 h. Extensive research has been carried out (using electronically monitored bottles) looking at this area of care and has shown a surprising lack of adherence.1 Patients occasionally use ‘pill timers’ at home to be exact with their timing, and a major area of patient education focuses on drug adherence and compliance. Drug preparations vary from dispersible to normal-release tablets and from patches to subcutaneous infusions. The timing and onset of action can vary, leaving the newcomer quite bamboozled. After time spent encouraging patients to be exact with medication, explaining that it should reduce the incidence of side effects and improve overall quality of life, it is often disappointing to see it all compromised by an inpatient stay.

Drugs can be poorly prescribed through lack of understanding, doses missed, and inappropriate nil by mouth orders. A study across all hospital wards has shown a delay in prescribing first and subsequent doses …

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