Introduction
Parkinson’ disease (PD) is a common chronic medical condition among the elderly population and it affects the nervous system. It is therefore a neurodegenerative disorder that begins to show symptoms in early 60s though some cases the symptoms can start as early as age 40. The disease is characterized by unilateral onset of clinical bradykinesia, postural rigidity and rigidity as well as resting tremors. This simply means that this chronic and progressive condition affects body movement. L-DOPA therapy is often given in addition to diagnosis criteria. PD is regarded as the second-most commonly diagnosed disease of the nervous system among the elderly population after Alzheimer’s disease.
Population Demographics General Impact on Health Market
The prevalence of PD is estimated to be 0.5 to 1% among men and women aged between ages 65 and 69 while for those aged above 80 years, the prevalence is 1 to 3%. In general, the disease affects 1 to 2% of the people above 60 years tough the disease has been diagnosed among younger people below 60 year as well (Willis et al, 2010, p. 143). The symptoms can begin to appear before a patient reaches 40 in 5-10% of patients.
Recent studies have indicated that the disease had inn incident rate of 16-19 per 100,000 people. According to the statistics provided by the Parkinson’s Disease Foundation, at least one million people in the US are affected by the disease and there are over four million cases worldwide (Willis et al, 2010, p. 143). Sex statistics indicate that men are more vulnerable to this medical condition compared to men across the races with a 3-2 ratio between ages 60 and 69. Nonetheless, at the ages over 75 years the ratio of the disease occurrence is the same for both sexes.
Willis et al, 2010, p. 143 studies on the racial incidence statistics show that Caucasians are more prone to the disease than the African Americans (lowest prevalence), Hispanics and Asians with a prevalence of 66-187 cases per 100,000 people per year. Whereas the Caucasians are most vulnerable, African American living in the same location will have same prevalence to suffer PD as the Caucasians. While PD is a disease common in the aging population, at least 40% of the patients could be under-diagnosed; therefore, as statistics indicate that about 1 million people in the US are having the disease, the number could be much greater (Willis et al, 2010, p. 145). This because the disease presents varying symptoms which are in most cases misdiagnosed.
PD has become an expanding medical problem in the current or modern society as the incident rate keep on increasing despite improving medical care. As the world continues to face burgeoning elderly population, it is pertinent for the community health nurses to be in a good position to care and manage these patients (Huse, 2005, p. 1451). The impact of these increasing numbers has been seen in the increased numbers of new researches in this field even though the cause of idiopathic PD remains much of a mystery.
There has been increased participation of local and nations agencies that seek to offer the patients and their caregivers a proper education, support and referrals. This is because the impact of the disease on the patient and family and friends are intense. With such big older population in the US, many families are currently affected hence putting pressure on the healthcare system (Fischer, 1999, p. 193). There is increased need for registered nurses to work as care givers, there need for doctors, monetary resources, healthcare facilities, and more social workers.
The implications are diverse and nurses are always seeking to stay abreast with the growing challenges and developments in Medicare and managed care systems to make sure that patients receiving home care also access these required services (Fischer, 1999, p. 194). Being able to have more community health nurses will provide a very crucial connection in the healthcare system for the Parkinson’s disease patients.
Major Challenges
The two main and related challenges facing the PD patients are the cost of medical treatment and the access to home care. The cost of treating PD include the direct and indirect expenses where the direct costs entails the expenses on medical and non-medical services that are required because of the disease condition (Huse, 2005, p. 1451). These expenses include the inpatient hospital costs, emergency room care expenses, cost on pharmaceuticals and physician care expenses. There are nonmedical expenses like transport and equipments purchases as well the indirect cost include reduced work productivity and ability as well as absent days due to medication (Fischer, 1999, p. 196).
PD being a progressive disease, it becomes severer as it progresses and also requires more medical attention and support (Huse, 2005, p. 1451). The patients require help of a friend of family member or a nurse in case the first two are not available or cannot offer the type of support required. The disease is physically and emotionally challenging with help need for domestic chores, nursing assistance, finance, hospital daycare or even professional care (Huse, 2005, p. 1451).
The main financial burden lied on the shoulders of the patient and their families. The Parkinson’s Action Network research revealed that the common pharmacotherapeutic drugs for the management of PD cost up to $6,000 annually to treat one patient. Furthermore, other medical care expenses like treating co-morbid diseases of PD, paying for physician visits and physical therapies are approximated to be between $2,000 and $7,000. This is in fact only for the disease cases that are diagnosed early enough, as the cost increases drastically as progresses pathologically to the advanced stages (Willis et al, 2010, p. 146).
PD’s surgical treatment cost over $25,000 and when the disease is in its advanced stages, there is need for an institutional care at an assisted-living facility where the cost is estimated to exceed $100,000. With such figures and bearing in mind that there are over 1 million US patients suffering from PD, it’s clear that the medical condition is an enormous economic burden to the nation (Willis et al, 2010, p. 147). With over 40% of the patients under 60 year, the workforce is tremendously affected. According to expert opinion, about one third of employees may lose their job due to PD. This is a blow to productivity of a country because of the disease (Huse, 2005, p. 1454).
Homecare is a major challenge for the PD patients (Fischer, 1999, p. 197). In most cases older people stay alone because various reasons including spreading of family, working needs, death of a spouse among others. This raises a great issue of support since the PD patients face challenges of mobility, whether it is a spouse, a family member of a nurse. These individual have to be knowledgeable about the disease. Sometimes there is lack of qualified caregivers even though this does not necessarily call for professional unless in the advanced cases (Huse, 2005, p. 1456). Caregivers often get worried about the future, economic loss, increasing dependence of the patient on their support, and risk of permanent disability. This can as well cause anxiety and depression on the caregivers.
In most cases, it’s the family members who offer primary care to their loved one with some assistance from home healthcare nurse, specialist therapists and visiting doctor as the disease advances (Fischer, 1999, p. 193). The homecare attributed cost from the largest percentage of direct costs at 19.9 percent.
Wellness Plan and PD Service Needs
The key to effective management of PD is usually early diagnosis and early treatment. However, diagnosis has been as challenge since the practitioners rely on the clinical finding and there is lack of specific process of diagnosis the diseases like use of biomarkers (Marek et al, 2008, p. 113). The clinical diagnosis demands that three be at least 2 out of the four cardinal signs;
- Rigidity which is the decreased independent movement in terms of direction and speed (Marek et al, 2008, p. 113)
- Postural instability which is difficulties of balancing the body well
- Bradykinesia which is the slowed movement, decreased movement range and hardship of performing repetitive movements (Marek et al, 2008, p. 113)
- Rest tremor which is the shaking of the body parts with disappearance of tremor with movement in the facial muscles, limbs and the jaw.
As already indicated, a very big percentage of patent are probably undiagnosed, therapy is therefore affected greatly since the disease progresses to advanced stages before it is discovered. The management of PD requires a standard protocol to diagnose this problem (Marek et al, 2008, p. 115). Several efforts have been made to devise such process and few suggestions have been proposed. The commonly used is the UK Brain Bank criteria which comprise consideration of the presence Bradykinesia as vital sign plus another symptom like rest tremor, rigidity and postural instability for a positive diagnosis to be made.
This process faces a great challenges considering that most of the symptoms are individually determined, for instance about 30% of PD patients do not present resting tremor (Marek et al, 2008, p. 116). There needs to be a strategy if diagnosing the disease by analyzing neurodegenerative activity. Furthermore, in case the physician suspects presence of PD, he/she should recommend that the patient sees a neurologist to begin management of the reducing levels of dopamine in the brain, alleviating the PD symptoms and decreasing the side effects.
Besides diagnosis, there is not approved treatment for the condition to stop or slow the disease progress. There needs to be more studies on the disease so that practitioners can find the best methods of diagnosing the problem and treating it as well (Schapira & Obeso, 2006, p. 560). However, currently, the main goal of treating PD patients is just to help patient attain independence.
How Individuals and Community Address PD Challenges
PD is a very costly neurodegenerative disorder and this damning fact has to be address both by individual patients and the entire community so that there is enough funding for proper and innovative medication (Schapira & Obeso, 2006, p. 560). The indirect costs are much greater that direct expenses since over 50% of them are still accounted for by the prescription drugs. The current epidemiological information on the disease specific statistics could be insufficient for use in the precise health economic assessment (Schapira & Obeso, 2006, p. 561). Without this information it would be very difficult to determine the best areas to invest in order to manage this neurological disorder.
The communities should be ready to participate in the epidemiological studies to offer more disease specific data collected through the proper healthcare process with more involvement of neurologists. Communities can also offer support I community healthcare centers where people can volunteer their services to take care of patients (Schapira & Obeso, 2006, p. 561). Individuals can always the risk factors and seek medical checkup which can result in early diagnosis hence proper treatment.
Reference List
Fischer, P.P. (1999). Parkinson’s Disease And The U.S. Health Care System. Journal Of Community Health Nursing, 16(3), 191-204.
Huse, D. M. (2005). Burden of Illness in Parkinson’s Disease. Mov Diord, 20(11),1449-1454.
Marek, K., Jennings, D., Tamagnan, G., & Seibyl, J. (2008). Biomarkers For Parkinson’s Disease: Tools To Assess Parkinson’s Disease Onset And Progression. Ann Neurol, 64 (2),111- 121.
Schapira, A. H, & Obeso, J. (2006). Timing Of Treatment Initiation In Parkinson’s Disease: A Need For Reappraisal. Ann Neurol, 59(3), 559-562.
Willis, A.W., et al. (2010). Geographic And Ethnic Variation In Parkinson Disease: A Population-Based Study Of US Medicare Beneficiaries. Neuroepidemiology, 34, (3), 143-151.