Personalized Care in Late-Stage Parkinson's Disease: Challenges and Opportunities.
Margherita FabbriMiguel CoelhoMichela GaronRoberta BiundoTiago A MestreAngelo Antonininull On Behalf Of iCARE-Pd ConsortiumPublished in: Journal of personalized medicine (2022)
Late-stage Parkinson's disease (LSPD) patients are highly dependent on activities of daily living and require significant medical needs. In LSPD, there is a significant caregiver burden and greater health economic impact compared to earlier PD stages. The clinical presentation in LSPD is dominated by motor and non-motor symptoms (NMS) that most of the time have a sub-optimal to no response to dopaminergic treatment, especially when dementia is present. Non-pharmacological interventions, including physiotherapy, cognitive stimulation, speech, occupational therapy, and a specialized PD nurse, assume a key role in LSPD to mitigate the impact of disease milestones or prevent acute clinical worsening and optimize the management of troublesome NMS. However, the feasibility of these approaches is limited by patients' cognitive impairment and the difficulty in delivering care at home. The present care challenge for LSPD is the ability to offer a person-centered, home-delivered palliative care model based on Advanced Care Planning. An ongoing European multicentric project, PD_Pal, aims to address this challenge.
Keyphrases
- palliative care
- healthcare
- quality improvement
- end stage renal disease
- cognitive impairment
- advanced cancer
- chronic kidney disease
- newly diagnosed
- public health
- prognostic factors
- pain management
- peritoneal dialysis
- mental health
- affordable care act
- risk factors
- intensive care unit
- health information
- patient reported outcomes
- liver failure
- social media
- patient reported
- human health
- sleep quality
- respiratory failure
- extracorporeal membrane oxygenation