1. Lorna Gillies Parkinson’s Nurse Specialist
Palliative care case study
Lorna Gillies Parkinson’s Nurse Specialist

2. Idiopathic Parkinson's is a progressive neurological condition
Symptoms are due to lack of dopamine due to cell death
Symptoms –bradykinesia, rigidity and tremor-plus non motor symptoms
Cause, many theories, likely a combination of genetic and environmental factors
Atypical Parkinson's and parkinsonism's
No cure or disease modifying therapy yet

3. Phases of Parkinson’s Maintenance Diagnosis Education Education
Support
Drug therapy
MDT
Diagnosis
Education
Support
MDT
Acceptance
Reduce symptoms
Carer support
Complex
Complex drug regimes
Side effects
Co morbidities
Wider MDT
Reduce symptoms
Maintain normal
activities
Anticipatory care plan
DNACPR
Palliative
Palliative care referral
Drug withdrawal
Alternative drug route
Symptom control
PEG

4. Case Study 87 year old gentleman Parkinson’s diagnosed 2012
Gradual deterioration
Cognitive impairment
Medication less effective-co morbidities
PKAVs and care package involved
Admitted to care home for respite-permanent

5. Case Study cont Referral to psychiatry Frail Reduced appetite
Increased somnolence
Swallow intact
Approaching Christmas

6. Case Study cont
Request GP to prescribe Rotigotine 2mg patch to replace oral meds if swallow deteriorates
Rotigotine obtained by care home
Peaceful death on Sunday

7. Learning points Anticipatory care planning Team work
Management of Parkinson’s in acute settings(NBM Guidelines) need adapted and rolled out to Primary care

8. Thank you
Gill Finlay Parkinson’s Nurse Specialist Royal Victoria Hospital
Tel e mail
Lorna Gillies Parkinson’s Nurse Specialist Perth Royal Infirmary Tel e mail
Linda Patterson Parkinson’s Nurse Specialist Stracathro Hospital Tel / e mail
Catherine Young Movement Disorder Nurse Specialist Ninewells Hospital Tel ex e mail