1. What predicts hospital admissions in community-dwelling people with Parkinson’s?
Roshan Sebastian MBBS,1 William K. Gray PhD,1 Aishling Foley MBBS,2 Lydia Trendall MBBS,2 Doori Oh MBBS2, Annette Hand ProfD1,3 Steve Dodds MSc,1 Elliot McClenaghan BSc,2 Vasco Dos Santos MBBS,4 Lloyd L. Oates MSc,1 James Fisher PhD,1 Richard W. Walker MD1,5
1. Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, UK. 2.The Medical School, Newcastle University, Newcastle-upon-Tyne, UK. 3. Department of Nursing, Midwifery and Health, Northumbria University, Newcastle-upon-Tyne, UK 4. Faculty of Medicine, University of Lisbon, Portugal 5. Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne, UK
OBJECTIVE
Previous studies have looked at the reasons for hospital admission in people with parkinsonism (PwP), yet few have looked at factors that precipitate admission.
RESULTS
One-hundred and sixty-two patients consented to participate.
The mean age was 73.9 years (SD 7.80, range 52-90)
99 (61.1%) males.
One-hundred and forty-two PwP (87.7%) had a diagnosis of idiopathic PD, 10 (6.2%) had PD dementia, 5 (3.1%) MSA and 5 (3.1%) PSP.
The median disease duration 7 years (IQR 5-11).
Disease stages for those with PD were: III, n= 90 (59.2%); IV, n= 55 (36.2%); and V, n= 7 (4.6%).
Seventy-one PwP (43.8%) had at least one hospital admission, 17 patients (10.5%) had three or more admissions to hospital.
There was no statistically significant difference in the variables of age, sex, H&Y stage, age at disease onset or disease duration between PwP who were not admitted.
Those admitted to hospital had poorer cognition, more non-motor symptoms, poorer quality of life, slower timed-up-and-go test scores and more abnormal swallow.
They also had poorer UPDRS section 1 (non-motor symptoms), UPDRS section 2 (motor symptoms) and UPDRS section 3 (motor examination) scores.
Multivariable analysis was conducted to identify independent risk factors for admission. The independent risk factors identified were; dizziness/light-headedness, cognitive impairment, anxiety and gait dysfunction (see Table 1).
BACKGROUND
In 2015, there were estimated to be 137,000 people with PD in the UK. The number of people with parkinsonism (PwP) is expected to increase rapidly in the coming decades1.
Compared to the general elderly, PwP are more likely to be admitted to hospital, have a longer admission and are more likely to have a hospital related complications 2.
Previous studies have looked at the reasons for hospital admission, however few have looked at baseline factors that could precipitate hospital admission for PwP 7.
Understanding precipitating factors may help healthcare services to work proactively to predict, and potentially prevent, some hospital admissions.
METHODS
As part of the 10 year Northumbria Care Needs Project PwP with a diagnosis of Idiopathic Parkinson’s disease of Hoehn and Yahr stage III-V, and those with Parkinson’s plus syndromes were assessed for motor and non-motor symptoms, quality of life and functional performance.
Data on hospital admissions over two-years were collated from clinical records from 1st January 2015 to 31st December 2016.
Admissions for any causes, whether parkinsonism-related or not, were recorded.
CONCLUSION
Our study emphasises the importance of non-motor symptoms in predicting admission. A cost-benefit analysis of early intervention to prevent admission should be considered.
ACKNOWLEDGEMENTS
This study was part-funded by a grant from Parkinson’s UK (Ref: G-1310). Northumbria Healthcare NHS Foundation Trust acknowledges the support of the National Institute of Health Research Clinical Research Network (NIHR CRN).
References
1. Parkinson's UK. The incidence and prevalence of Parkinson’s in the UK. 2018; Accessed 12th November..
2. Gerlach OH, Winogrodzka A, Weber WE. Clinical problems in the hospitalized Parkinson's disease patient: systematic review. Mov Disord. Feb ;26(2):
3. Woodford H, Walker R. Emergency hospital admissions in idiopathic Parkinson's disease. Mov Disord. Sep 2005;20(9):