How to Manage an Individual Living with Parkinson's Disease Who Acutely Cannot Swallow

Parkinson's disease (PD) is a common neurodegenerative condition that can lead to problems swallowing. Individuals living with PD may be unable to take medications orally for various reasons including acute or chronic dysphagia, non-PD related causes and being placed nil-by-mouth for elective reasons. This article outlines a five-step approach to managing an individual living with PD who is unable to take oral medication acutely. This includes assessment for the appropriateness of nasogastric tube insertion and the conversion of an individual's usual medication regimen to either a dispersible one or to a topical patch if a nasogastric tube is not possible. A patient-centred multidisciplinary approach is important, with shared decision-making involving the individual and their next of kin with key members including the Speech and Language Therapy and dietetic teams. The patient should be reviewed daily with their medication titrated according to clinical response, aiming to restart their usual regimen as soon as possible.