Characteristics of Patients with Late-Stage Parkinsonism Who are Nursing Home Residents Compared with those Living at Home.
OBJECTIVES
To determine clinical characteristics and treatment complications of patients with late-stage Parkinsonism living in nursing homes compared with those living at home.


DESIGN
Cross-sectional analysis.


SETTING AND PARTICIPANTS
This study is an analysis of 692 patients with late stage Parkinsonism recruited to an in-depth international study, Care of Late-Stage Parkinsonism (CLaSP).


MEASURES
Sociodemographic characteristics were compared between patients who were living in a nursing home (n = 194) and those living at home (n = 498). Clinical assessments included the Unified Parkinson's Disease Rating Scale (UPDRS), the nonmotor symptom scale, the neuropsychiatric inventory, and a structured interview of patients and carers. Predictors of nursing home status were determined in a multivariate analysis.


RESULTS
Nursing home placement was strongly associated with more severe cognitive impairment, worse UPDRS motor scores and disability, and with being unmarried and older. Although nursing home residents had significantly higher axial scores, falls were less common. Despite similar levodopa equivalence doses, they had less dyskinesia. Nonmotor symptom burden, particularly delusion, hallucination, and depression scores were higher in nursing home residents, and they were more frequently on psychotropic medication. They had lower rates of dopamine agonist use and lower rates of impulse control disorders. In multivariate analysis, being unmarried, presence of cognitive impairment, worse disease severity as assessed on the UPDRS parts II and III, severity of delusions, and lower rate of dyskinesia were associated with nursing home placement.


CONCLUSIONS AND IMPLICATIONS
These clinical characteristics suggest that in patients with Parkinsonsim who are nursing home residents, presence of cognitive impairment and delusions particularly add to the higher overall symptom burden, and more often require specific treatments, including clozapine. Despite similar levodopa equivalent daily dose, motor severity is higher, and dyskinesias, indicative of a response to levodopa, are less common. Falls, however, also occur less commonly, and dopamine agonists are less frequently used, with lower rates of impulse control disorder.
['Hosking|Alice|A|', 'Hommel|Adrianus A L J|AALJ|', 'Lorenzl|Stefan|S|', 'Coelho|Miguel|M|', 'Ferreira|Joaquim J|JJ|', 'Meissner|Wassilios G|WG|', 'Odin|Per|P|', 'Bloem|Bas R|BR|', 'Dodel|Richard|R|', 'Schrag|Anette|A|', '|||']
D003430:Cross-Sectional Studies D006801:Humans D007980:Levodopa D009735:Nursing Homes D010300:Parkinson Disease D020734:Parkinsonian Disorders
Late-stage Parkinsonism treatment nursing home placement falls delusions