Nursing care of patients with late-stage Parkinson's disease

Patients in the late stages of Parkinson's disease may be significantly disabled for many years, often because of their increasing inability to tolerate therapeutic doses of antiparkinson drugs. Their status and management have been overlooked in the literature. Few current healthcare professionals have cared for patients with Parkinson's disease in the prelevodopa era and do not understand how severe and protracted the illness can be without effective treatment. This article describes a practical approach to the nursing management of severely affected patients (i.e., Hoehn and Yahr Stage 4-5) who no longer derive consistent, therapeutic benefit from their drugs. Specific problems these patients face are adverse drug reactions such as postural hypotension, psychosis, and confusion, as well as difficulties with nutrition, elimination, mobility and falling, communication, sexuality, memory, and mood. Nursing interventions can help minimize the effect of these problems on the patient.