The psychosocial impact of late-stage Parkinson's disease

The late stage of Parkinson's disease (PD) can be protracted with inexorable changes in physical and mental health, loss of autonomy and self-esteem, altered relationships, and social isolation. Severely affected patients (Hoehn & Yahr stage 4-5) present a challenge to nurses who care for them; addressing their needs takes time and patience. Changes in mental status have profound implications for the welfare of the late-stage PD patient as well as of the caregiver(s). Depression and dementia in patients with PD are two factors that interfere with the ability to deliver effective care in late-stage PD as they lead to loss of initiative and cooperation. Primary caregivers often have their own medical problems, with limited stamina and support; relationships may change, leading to sadness or conflict. Nurses can be powerful advocates for the physical and mental health of both the patient with late-stage Parkinson's disease and the primary caregiver.