| Abstrakt: |
The prevalence of Parkinson's disease (PD) increases with age. Caring for people with this condition frequently requires it to be considered within a wider context of both health and social factors. Diagnosis is made eliciting the hallmark motor signs, which can be confounded by signs from other co-morbidities such as depression, arthritis and cognitive impairment. The disease can be divided into four stages – diagnostic, maintenance, complex and palliative – reflecting an individual's needs. Alternative approaches include the Braak, and Hoehn and Yahr, stagings, using pathophysiological and clinical features, respectively. Dopaminergic therapies are as effective in older people, but compliance, tolerability, drug–disease and drug–drug interactions must be considered. Complications of disease are prevalent in older adults and include falls, fractures, cognitive impairment and orthostatic hypotension. Proactive screening and intervention are warranted to prevent the excess risk of morbidity and mortality associated with these events. Providing holistic and integrated care for older adults is complex and therefore best delivered by a multidisciplinary team with a proactive and patient-focused approach. A skilled and meticulous approach is required to tackle the complexity that results from the interplay between PD, co-morbidity, frailty and wider care and psychosocial factors. |
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