While in hospital a patient’s medication can be established, it can also give opportunity for nursing staff to assess and give advice on the problems which the patient is encountering. Harrison (2000) However for the patient hospitalisation may prove to be stressful and cause disruption in their routine, medication may be altered and the patient may suffer from a lack of self worth feeling that their independence is diminishing. Age discrimination can also take place with older people as it is often felt that a patients dignity is not respected, also patients conditions are often not taken as seriously as most of their symptoms are related to age.
For this reason the national service framework for older people was brought out to address issues such as ageism. It is a ten year programme promoting good health and giving support by using appropriate services by fitting those services around peoples needs. DOH (2001) Standard six aims to reduce falls and other related injuries, by introducing fall prevention guidelines, and promoting effective treatment and rehabilitation of those who have fallen. However Hughes (2002) carried out a study focusing on primary and secondary care services in London found that they were unlikely to be effective as services in London were not properly prepared to deliver them.
When the patients condition is stabilised then effective discharge from hospital to home may take place, a case conference must take place ensuring all members of the Multidisciplinary team are present, the patient and family should also be present as goals would be set to ensure the patient remains independent once back in their own environment, whether that be residential care, sheltered accommodation or the family home. Kemp et al (2002) Previous to discharge the Occupational Therapist who is directed towards educating the patient and assisting in maintaining the patients abilities for as long as possible would have carried out a home assessment ensuring that the patient will be returning to a safe environment that they can adequately manage. Turner et al (1996)
All discharges from hospital are based on legislation and government initiatives focusing on primary and secondary care and away from acute hospital services. DOH (1989a).The transition from hospital to home should be a smooth and all care packages implemented before discharge. This type of discharge should be seamless meaning that the care of the patient is continuous. Audit Commission (1996).
However this type of discharge is under increasing demand and discharge is often quick and without a case conference or home visits taken place. Salter (2001) Discharge planning is a vital process that should begin on admission, this would ensure that the patients physical, social and psychological issues could be cared for effectively as poor discharge would involve the patient been re admitted if appropriate care packages were not implemented. This is not only distressing for the patient but is also a drain on recourses. Salter (2001)
When a patient has been discharged and returned to their home, whatever diverse setting that may be they will be cared for in the community. The community care act (1990) was initiated to enable people requiring care to effectively receive that care in their own homes. Clarke (1999) Community care uses a framework for the provision of all health and social care services, there aim is to meet the needs and deliver the services required. Community health professionals are at the for front of new initiatives dealing with many people in diverse setting and community services can also provide a lifeline for isolated people suffering with a chronic disorder. Audit Commission (1996).
It is often felt because of the degenerating effects of Parkinson’s Disease that the physical symptoms are more apparent and are therefore considered first as it is most of the physical effects that contribute to the social and psychological issues. RCN (2000) However a framework of holistic care is always followed ensuring all aspects of care are individually assessed and managed within the Multidisciplinary team. Heath (1995). The MDT would involve such members as Occupational Therapist, Physiotherapist, Speech and Language Therapist, Dietician G.P. and Parkinson Disease nurse specialist, all working towards an effective rehabilitation programme.
However it would depend on an individual’s condition as to who is involved in treatment. Roy et al (1998). The DOH (1986, 1989) encouraged the move towards MDT approaches, which were dependant on the high level of co operation between the members of different professions within the team. Each member must understand their own role and the role of the other team members. Mc Gee (1996).
Information from all members of the health care team is vital for the patient to gain the best care possible. The team must also communicate effectively and interact with the team and patient; they must pass on information to ensure there is no overlap as this can be repetitive and unnecessary for the patient. Castledine (1996). However it is often felt that the role of the Occupational Therapist and Physiotherapist overlap often causing confusion for the patient and family, therefore it is essential that the patient and family have adequate information to understand the difference and why each member is involved. Turner (1996)
The progressive nature of Parkinson’s disease will probably require that a client and family maintain contact with the Occupational Therapist over a period of many years. The Occupational Therapist will often carry out an initial assessment, set goals, and use appropriate interventions, the patient should then receive regular re assessments. Turner (1996). The treatment required will vary as some people may have minor symptoms for many years, while others may become severely disabled and require full nursing care. The aim of the Occupational Therapist is to enable the patient to maintain as much independence and function as possible on the activities of daily living, by adapting to the loss of motor skills and using adaptive aids, whether it is for cooking, feeding, communicating or toileting. Lieberman et al (1995).
The patient may suffer with long term problems such as mobility, personal care, dressing, and elimination. The Occupational Therapist may suggest such things as bed or chair transferring using equipment to heighten the furniture, this may reduce the risk of falling if the person is not stooping or bending unnecessarily. Washing bathing and personal hygiene may become difficult for the sufferer without equipment, people with Parkinson’s disease have an oilier skin than usual and therefore need to wash and bath more frequently, grab rails, non slip mats and other equipments are advisable, enabling a person to carry on with life as normal as possible before diagnosis.
Caird (1991) It is also essential that the Occupational Therapist recognises the patient’s ability to maintain their own safety, and not only deals with the physical aspect of the disease but also the social problems that will affect the patient, treatment would take the form of rehabilitation, by preventing complications, promoting independence and maintaining independence where ever possible. The patient would be actively involved with their own treatment discussing their goals and long term care; this often empowers patients giving them a greater self worth. Turner et al (1996).
Dysphagia and drooling are mainly present in the later stages of the disease, however it does occur in approximately 80% of people suffering from Parkinson’s disease therefore an assessment with a speech and language therapist is required to determine an individual’s plan of care, including safe swallowing and consistency of diet and fluids. Penman & Thomson (1998). For this reason it is essential that a patient is monitored for aspiration, malnutrition and dehydration, as weight loss is a common feature of Parkinson Disease, which could be a result of increased metabolic demand, reduced appetite and swallowing difficulties.
Patients often complain of something sticking in their throats or chest during swallowing, this often causes them to panic resulting in them refusing to eat. Perry (2001) A speech and language therapist would be able to advise on the most beneficial treatment and most appropriate food textures. Diets of thickened liquids or pureed foods are often necessary but can have a profound psychological impact on the patients.
The Appearance of purd meals usually look unappetising and ‘like baby food’. Hotaling (1992). It is suggested that the meal such as the meat, potatoes and vegetables should be liquidized separately to retain individual colours and tastes. Patients often find the coughing, spluttering and loss of food from the mouth very degrading and upsetting, resulting in patients becoming socially isolated and not experiencing the usual pleasures from mealtimes. (Siebens,1986, 1999; Shaw and Power, 1999). Self esteem and self confidence often leave them feeling embarrassed and frustrated, resulting in the patient eating alone.