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  • Subject Name : Nursing

Introduction to Parkinson's Disease

Parkinson's disease (PD) is recognized as the illness of an elderly people, because it is most commonly identified in adults over the age of 60. Until age 50, just four percent of all cases are diagnosed. After Alzheimer's, PD is the second most common age-related neuron degenerating condition (Selvaraj & Piramanayagam, 2019). The prevalence of PD is 1 percent of its over 60 age population. It raises the populace over the age of 85 to 5 percent. This renders aging the greatest risk factor for PD growth. Gender is the single largest risk factor for PD (Khan et al., 2019). While the precise reason remains unclear, scientists agree that PD stems from a combination of environmental and genetic influences. In this essay, Parkinson's disease and the role of the care worker in assessing the patient is discussed along with the underlying causes of the symptoms of the PD.

PD affects numerous corporeal and brain regions. Motor signs are primarily responsible for the death of nerve cells (neurons) in a brain area called the substantia nigra. Such signs include tremors, trembling, and a sudden lack of movement. Caregiving is described as anything we do to support a family member or friend because of the illness or injury of that person, and what we do for our health (Keating et al., 2020). Although PD is unpredictable a carer 's function can shift as the disease moves forward. Individuals with late-stage PD require more support with daily tasks than people at the onset of disease. Each patient seems to have their own different experience when learning about PD but not everyone encounters every symptom. Cognitive dysfunction in older adults has several potential causes, including side effects of medication, metabolic and/or endocrine derangements, delirium due to intercurrent illness, depression, and dementia (Hand et al., 2019). Many triggers may be reversed with therapy, such as side effects of the drug and depression. The other symptoms cannot be changed, like Alzheimer's, but complications can be handled over time and by the support of the relatives, family, and friends. Many times patients themselves want a diagnosis of their memory, along with the cognitive or behavioral problems so that the patient can know the severity of the condition (Read et al., 2019).

Many times, patients hesitate to address the signs and symptoms because they expect a diagnosis of PD and the confusion it presumes. In these cases, a primary care provider should explain the benefits of figuring out the diseases on time and the consequences of hiding it. It takes just 10 minutes or less for qualified professionals using widely available screening equipment to immediately test a patient for cognitive disability (Goldman et al., 2018). While the findings of screenings are still inadequate to diagnose cognitive ability, they represent a major initial step. The other potential instruments for assessment are the AD8 and Mini-Cog. The good screening results require more assessment (Yang et al., 2016). The best way to more accurately evaluate cognitive disability is to incorporate cognitive tests with input from an individual who has regular interaction with the patient, such as with a partner or other caregiver. Interviews to assess memory, actions, behavior, and cognitive ability (complex activities such as managing money and driving) are best done only with patient alone, so that family members or partners cannot influence the patient (Carpenter et al., 2019). Data could also be obtained from the conduct of the patient upon arrival at the clinic and conversations with staff. Consider the patients with only mild disability can be able to cover up their cognitive deficiencies and are unwilling to discuss the issue.

Frailty is most commonly seen in patients 75 and older with cognitive or physical impairments that interfere with the efficiency of their everyday living tasks. Physical frailty is characterized as a dependency in at least one everyday living task, or cognitive impairment, or an outside movement decline (Espinoza, Quiben & Hazuda, 2018). ADLs include washing, dressing, lavatories, moving, continence, and feeding. ADLs also include the freedom to use telecommunications facilities, purchasing, food storage, home maintenance, washing, commuting, accountability for medicines, money management, mobile use, household chores, and accountability for medication. A functional assessment is also used to identify the present and potential needs of the most vulnerable elderly people in healthcare services and psychosocial matters (Grande et al., 2019). The systematic evaluation of the vulnerable elderly patient offers valuable predictive and therapeutic information and serves as a framework for a deeper understanding of the long-term and immediate wishes and desires of patients and families.

A functional assessment is a multifaceted and frequently integrative diagnostic procedure, which measures and quantifies the psychosocial, medical, and functional status of an aged person. Data obtained in this method can be used by physicians, the participant, and family to create a detailed plan for treatment and future treatment decisions, which can also help in the decision-making phase of long-term care (Schulz et al., 2016). Primary care professionals, both doctors and nurses, are in a crucial role to determine the functional state of patients and prioritize measures to avoid further deterioration of functionality and to sustain many elders' self-care status. Taking out an office-based functional assessment checks the elder's ability to exercise self-care and perform the necessary day-to-day social activities (Michelson & Chen, 2016).

Caregivers face several challenges, including physical, health, and emotional ones. The caregiver is also their loved one's health care advocate, handles prescriptions and appointments, and helps with everyday treatment, such as grooming and getting ready. The caregiver also gives comfort and support to their loved one, as they would be coping with high rates of chronic, debilitating illness. The caregiver's function in PD is continually evolving, with the requirements that grow as the condition worsens and creates new problems (Bail & Grealish, 2016). In the early stages of the illness, carers help the patient to deal with the diagnosis and learn to handle the medications for the patients. The caregivers should motivate and assist patients in the practice of everyday physical therapy to aid them because of their slowness of movement.

When a person's condition progresses into the mid-stage, the responsibilities and workload of the caregiver increase dramatically. Regular plans can be disrupted by exhaustion and unnecessary daytime sleepiness, and concerns around contact can increase. Caregivers are facing major pressure and difficulties in the late stage of PD (De Lima et al., 2017). A patient may have severe mobility issues, so carers also offer a lot of hands-on support. Many people with late-stage PD encounter incidents of freezing, sudden yet brief impotence. Freezing episodes can cause falls, so preventing falling is important in the late stage of PD. Many technology assistive tools are available to help eat, dress, and walk people with late-stage PDs (Rosqvist et al., 2017). Late-stage PD could also trigger the change in people’s thoughts, such as memory loss, confusion, and even dementia. It is worth remembering and not every patient experience all the symptoms of PD, and the role of the caregiver will also differ based on the needs of their loved one.

Although there is presently no medication which can prevent or prolong the development of PD, therapy sometimes can efficiently relieve the symptoms. Senior-aged patients are far less likely to encounter side effects with levodopa treatment than younger patients with PDs. In the elderly, PD care aims to preserve the patient's level of operation and improve the quality of life. When PD patients are sedentary because of their disease, it's hard to reverse. Many older adults are burdened with sensory and/or cognitive disabilities that hinder their ability to hear, see, understand, or access health care services (Ribas et al., 2017). Extra efforts to communicate knowledge in a manner accessible to each patient, address logistical challenges, and promote patient-centered decisions, despite underlying age-related limitations, are critical aspects of treatment for older patients with PDs. Patient-centered elderly care priorities are essential to each patient's tailored approach to treatment. Older patients may not generally want longevity as their primary result, but may also have aspirations about improving pain, living independently or through function (Eggers et al., 2018). In each patient, the goals of treatment are different and depend on the patient's condition and life aspirations.

Conclusion on Parkinson in Aged Care

The disorder of Parkinson (PD) is known as an aged person's disorder, and age is the biggest risk factor. Individuals with late-stage PD need more regular task assistance than those at the start of illness. For older people, there are several potential reasons for cognitive decline including side effects and complications. Many patients are hesitant to answer these concerns even though they are awaiting a PD diagnosis and the uncertainty it presumes. In such cases, a primary care provider will clarify the advantages of figuring out what will cause medical problems for the patient. Caregivers should motivate and assist their loved ones in the practice of everyday physical therapy to aid them because of their slowness of movement.

References for Parkinson in Aged Care

Bail, K., & Grealish, L. (2016). ‘Failure to Maintain’: A theoretical proposition for a new quality indicator of nurse care rationing for complex older people in hospital. International Journal of Nursing Studies63, 146-161.

Carpenter, C. R., Banerjee, J., Keyes, D., Eagles, D., Schnitker, L., Barbic, D., ... & LaMantia, M. A. (2019). Accuracy of dementia screening instruments in emergency medicine: a diagnostic meta‐analysis. Academic Emergency Medicine26(2), 226-245.

De Lima, A. L. S., Evers, L. J., Hahn, T., Bataille, L., Hamilton, J. L., Little, M. A., ... & Faber, M. J. (2017). Freezing of gait and fall detection in Parkinson’s disease using wearable sensors: a systematic review. Journal of Neurology264(8), 1642-1654.

Eggers, C., Dano, R., Schill, J., Fink, G. R., Hellmich, M., Timmermann, L., & CPN study group. (2018). Patient-centered integrated healthcare improves quality of life in Parkinson’s disease patients: A randomized controlled trial. Journal of Neurology265(4), 764-773.

Espinoza, S. E., Quiben, M., & Hazuda, H. P. (2018). Distinguishing comorbidity, disability, and frailty. Current Geriatrics Reports7(4), 201-209

Goldman, J. G., Holden, S. K., Litvan, I., McKeith, I., Stebbins, G. T., & Taylor, J. P. (2018). Evolution of diagnostic criteria and assessments for Parkinson's disease mild cognitive impairment. Movement Disorders33(4), 503-510.

Grande, G., Vetrano, D. L., Fratiglioni, L., Marseglia, A., Vanacore, N., Laukka, E. J., ... & Rizzuto, D. (2019). Disability trajectories and mortality in older adults with different cognitive and physical profiles. Aging Clinical and Experimental Research, 1-10.

Hand, A., Oates, L. L., Gray, W. K., & Walker, R. W. (2019). The role and profile of the informal carer in meeting the needs of people with advancing Parkinson's disease. Aging & Mental Health23(3), 337-344.

Keating, C. E., Browne, K. D., Duda, J. E., & Cullen, D. K. (2020). Neurons in subcortical oculomotor regions are vulnerable to plasma membrane damage after repetitive diffuse traumatic brain injury in swine. Journal of Neurotrauma.

Khan, A. U., Akram, M., Daniyal, M., & Zainab, R. (2019). Awareness and current knowledge of Parkinson’s disease: a neurodegenerative disorder. International Journal of Neuroscience129(1), 55-93.

Michelson, I. R., & Chen, C. (2016). Caring for Caregivers. Caring for the Military: A Guide for Helping Professionals, 111.

Read, J., Cable, S., Löfqvist, C., Iwarsson, S., Bartl, G., & Schrag, A. (2019). Experiences of health services and unmet care needs of people with late-stage Parkinson’s in England: A qualitative study. PloS One14(12), e0226916.

Ribas, C. G., da Silva, L. A., Corrêa, M. R., Teive, H. G., & Valderramas, S. (2017). Effectiveness of exergaming in improving functional balance, fatigue, and quality of life in Parkinson's disease: A pilot randomized controlled trial. Parkinsonism & Related Disorders38, 13-18.

Rosqvist, K., Hagell, P., Odin, P., Ekström, H., Iwarsson, S., & Nilsson, M. H. (2017). Factors associated with life satisfaction in Parkinson's disease. Acta Neurologica Scandinavica136(1), 64-71.

Schulz, R., Eden, J., & National Academies of Sciences, Engineering, and Medicine. (2016). Family caregiving roles and impacts. In Families caring for an aging America. National Academies Press (US).

Selvaraj, S., & Piramanayagam, S. (2019). Impact of gene mutation in the development of Parkinson's disease. Genes & diseases6(2), 120-128.

Yang, L., Yan, J., Jin, X., Jin, Y., Yu, W., Xu, S., & Wu, H. (2016). Screening for dementia in older adults: Comparison of mini-mental state examination, mini-cog, clock drawing test, and AD8. PloS One11(12), e0168949.

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