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Caring Patients with Parkinson’s disease

How does Parkinson’s disease affect daily lives?

Patients with Parkinson’s disease may suffer from hand tremor, rigidity of joints, slow movement and walking instability which affect their daily lives. Family members and carers should help patients to maximise their independence and abilities, rather than do everything for them to prevent deterioration of their self-care abilities. In general, carers should assist patients according to their needs and abilities. Applying appropriate techniques including using suitable assistive devices when necessary as well as providing encouragement to patients would help them optimise their self-care ability.

The caring tips below apply to patients with different stages of impairment of activities of daily living. Carers can apply these caring skills according to individual's need.

Tips for Daily Living

1.Feeding

Aim Points to note
For easier feeding Encourage self-feeding and use assistive devices as appropriate. For example, use non-slip mat to fix utensils. Scoop from a bowl with a raised curved lip. Weighted cup with enlarged handles reduces hand tremor. Patients without swallowing difficulty whose hand tremors stop them from holding the cup firmly can use a straw. Straw can reduce the chance of choking as it does not require tilting the head while drinking.
To avoid choking Sit up with back straight and chin down during mealtime. Do not lie down or tilt the head backwards while eating. Cut food into smaller pieces or prepare pureed meals. Food which is too dry (e.g. crackers, toasts), too slippery (e.g. jelly, whole piece of grape etc.) or sticky (e.g. sticky rice wrapped in lotus leaf, etc.) may cause choking. Encourage patients to chew and swallow slowly and do not hurry them.
To prevent constipation Encourage high fibre diet (like vegetables, fruits, oatmeal etc.) and adequate fluid intake.

2.Dressing

Aim Points to note
For easier dressing Choose clothes which are easier to put on such as clothes with front opening and large buttons or Velcro. Replace zip with elastic band for trousers. Shoes fastened by Velcro are more convenient.
To prevent falls Sit down while putting on trousers. Avoid trousers which are too long or too loose. Shoes should be well-fitted and preferably with non-slip soles. Replace shoes when they look worn.

3.Getting up and transferring

Aim Points to note
For easier transfer Chairs and beds should be of suitable height to allow both feet be placed firmly on the ground while the patient is sitting on the bedside. Chairs with armrests can help with rising from the chair.
To prevent falls Always stand with feet apart for easy balancing.

4. Toileting and bathing

Aim Points to note
For easier toileting and bathing If the toilet is too low, a raised toilet seat can allow the patient to stand up more easily after toileting. Install handrails at suitable position.
To prevent falls
  • Use non-slip mats in tubs and shower stalls to prevent slipping.
  • Climbing in and out of the bath tub could be dangerous. Shower stalls are safer. Shower curtain is better than sliding glass door. Alternatively, a stable shower chair or a bathboard can be used. By using a hand-held shower hose rather than a fixed hose, the patient can wash his/her back without turning. (For further information, please consult healthcare professionals.)

5. Home environment

Aim Points to note
To prevent falls
  • Keep the passageway clear of unnecessary items to allow enough space for turning and use of walking aid. Loose wires should be fixed against the wall. Ensure the floor is flat and dry to prevent falls.
  • Ensure adequate lighting. Corridor and bedside lights facilitate going to the toilet at nighttime.
  • Place non-slip mats at toilet and kitchen entrances. Label door thresholds with sharp-coloured strips to alert the patient.
To prevent accident

Install an alarm call system if patient is living alone.

6. Communication skills

Aim Points to note
To communicate effectively
  • Reduce background noise. Sit face-to-face with patient. Keep good eye contact and listen attentively. Ask simple questions.
  • Encourage patients to speak slowly, use simple words or phrases and body gestures to facilitate communication e.g. nodding to indicate "yes".
  • If patients experience much difficulty with speaking, writing or drawing pictures on cards can help.

7. Mental health

Aim Points to note
To maintain mental well- being Patients are more prone to depression. Therefore, reassurance and support from family members and caregivers are very important. Watch for any changes in emotion or behaviour for early detection of depression.

8.Prevention of complications (For bed-ridden patients)

Aim Points to note
To prevent bedsores
  • Keep the skin clean and dry. Observe the skin condition of pressure areas for any signs of bedsores such as redness and ulcers.
  • Avoid prolonged staying in the same posture, change patient's position at least every 2 hours to avoid prolonged pressure on bony prominences.
  • Encourage the patient to perform appropriate exercise.
To prevent chest infection

Encourage adequate fluid intake and daily activities, sit up during mealtime, build up the body resistance and perform breathing and coughing exercises. These can help to reduce the chance of chest infection since patients may have difficulty in coughing and spitting.