Community Care for Individuals with Long-Term Neurological Conditions

Introduction

Long-term neurological conditions are a group of disorders that develop due to nervous system damage or disease that lasts a lifetime. These illnesses substantially impact an individual's profession, family, and society as a whole. The national hospital service (NHS) may be affected by this load (Peel, 2019). Parkinson's disease, caused by brain damage caused by aging, is an outstanding example of a neurological illness. The majority of people who get this condition are over 60 years old, making age the most significant risk factor. More than 10 million individuals in the United Kingdom (U.K.) suffer from a neurological illness that has a detrimental influence on their life, with more than 19 percent of the overall neurological population requiring hospitalization (Robinson et al., 2019). For those researching these impacts, seeking healthcare dissertation help can provide valuable insights. These illnesses are life-threatening and have a negative impact on one's quality of life. Improved community care can enhance care for these people across service lines and concentrate resources on the most vulnerable.

Parkinson's disease (P.D.)

It's characterized as a nerve system disorder that impairs mobility. Shaking, stiffness, and trouble gaining balance and coordination when walking are all symptoms of this neurological disease. The disease's symptoms appear gradually and develop over time (Peel, 2019). People may experience mental and behavioural changes and sleep issues, tiredness, memory loss, and depression. The illness can affect both men and women, although it affects males more frequently than women. Although most people with this disorder first develop the disease at about 60 years, age is an obvious risk factor, and about 10% of these people have early onsets (begins before 50 years) (Palfi et al., 2018). Parkinson's disease has been linked to gene mutations as early onsets forms have often been but not always inherited.

Cause of Parkinson's disease

The most significant risk factor for developing this illness is advancing age. The average age of onset is 60 years, with young adults rarely experiencing the disease. It ordinarily begins in the middle and late-life stages as the further risk advances with age (Malek et al., 2018). Aging affects many cellular processes that predispose to neurodegeneration and age-related changes. Accumulation of age-related somatic damages and failure of compensatory mechanisms leads to acceleration of Parkinson's disease.

Some cases of Parkinson's disease are hereditary, as the disease has been traced back to different gene mutations. However, genetic causes of this disease are rare as only 15% of those with the condition have a family history (Tan et al., 2019). Research shows that a combination of environmental factors (exposure to toxins) and genetics may cause Parkinson's disease. Men are more likely to develop Parkinson's disease than are women. The condition is 1.5 less common in females than in males. Symptomatic P.D. onset is delayed in females, with fewer symptoms in the pre-clinical phase environmental factors.

Potential Consequence of Living with P.D.

Parkinson's disease is typically associated with potentially long-term complications. A diagnosis of P.D., like any other chronic illness, can be life-threatening and scary. There are many misconceptions about P.D., and being aware of them is helpful to have an accurate outlook about the disease and its prognosis. One may experience cognitive problems such as dementia and thinking difficulties (Diez-Cirarda et al., 2018). This occurs at the later stage of the illness as these problems have grown resistant to medication. Some may experience mild cognitive impairments, along with finding it difficult to plan or accomplish tasks. It makes it harder for these individuals to focus in conversations entirely and cannot remember information or have trouble putting the right words together. Stress medication and depression can also contribute to these changes in cognitive behavior.

Falls

In persons with Parkinson's disease (P.D.), falls are a leading cause of disability, loss of independence, and poor quality of life. According to research, between 45% and 68% of persons with Parkinson's disease fall each year, with a high proportion (50–86 %) repeatedly is falling (Gupta et al., 2018). Furthermore, their risk of falls and fractures begins to grow gradually from 40, significantly sooner than in healthy people. Falls have catastrophic effects, including limitations on daily activities, fear of falling, high levels of caregiver stress, and injuries. Hip fractures are four times more common in persons with Parkinson's disease than in people without the disease.

Many people with Parkinson's disease (P.D.) suffer from debilitating and expensive falls, as they are twice as likely to fall as those with other neurological diseases. These falls have severe and far-reaching effects, frequently ending in damage and contributing to fear of falling, decreased activity levels, poor quality of life, and caregiver stress (Darweesh et al., 2018). Given that the prevalence of Parkinson's disease is anticipated to quadruple in industrialized nations between 2005 and 2030, PD-related falls are likely to impact healthcare systems in the future decades significantly.

The conditions surrounding falls may give insight into the underlying causes of falls and potential fall prevention methods. Outdoor falls in persons with P.D., for example, are primarily caused by slips and trips, but indoor falls are more closely linked to lower limb weakness, vertigo, and postural instability (Palfi et al., 2018). However, no research has looked at the differences between the postural instability and gait difficulty and tremor dominant subtypes in fall conditions, such as fall sites. Furthermore, only a few researchers have compared the two P.D. subtypes in terms of cognitive, functional, and mobility parameters.

While it is generally established that repeated falls are a concern for persons with Parkinson's disease, the scope and severity of the problem remain unknown. Recurrent falls are defined as an individual falling more than once in a particular period in the general elderly population (usually 12 months). According to these criteria, around 15% of the overall elderly population is categorized as repeat fallers. On the other hand, recurrent falls are common in persons with P.D. (Gupta et al., 2018). Furthermore, 13% of persons with Parkinson's disease reported falling more than once each week, with most of these people falling multiple times per day, according to a study of 100 people with the disease. This implies that the variables that cause recurrent falls in persons with Parkinson's disease differ from those that cause recurrent falls in the general population. As a result, fall evaluation and categorization methods and fall prevention treatments used in the general population may not be sufficient or appropriate for persons with Parkinson's disease (Hobson et al., 2018). There are numerous risk factors linked to falls in persons with Parkinson's disease. A history of falls, postural instability, gait freezing, leg muscle weakness, and cognitive impairment are examples. However, among persons with P.D., there appears to be a broad variation in the frequency of falls, and there is some indication that the risk factors for single falls may differ from the risk factors for repeated falls.

Risk factors

The primary motor symptoms of Parkinson's disease, such as rigidity (stiffness) and bradykinesia (slowness of movement), as well as related postural alterations, all increase the chance of falling. Axial stiffness, or a lack of flexibility and adaptation in the neck and trunk, causes postural instability (balance loss) and increases the risk of falling (Darweesh et al., 2018). Falls can also be caused by issues with the centre of mass or centre of gravity. The centre of mass of a human is right below the navel, and the legs provide support. It is typical for a person's centre or midsection to shift away from their base of support with Parkinson's disease.

Impaired postural reflexes, postural change, and freezing (the inability to initiate movement, as if one's feet were stuck to the floor) are all factors that can lead to falls. Another risk factor for PD-related falls is visual difficulties, such as double vision, hazy vision, and alterations in in-depth perception, which some persons with P.D. experience. Non-motor symptoms might also increase the likelihood of falling (Blauwendraat et al., 2020). For example, when a person with P.D. rises from a sitting or sleeping position, their blood pressure drops, causing light headedness and perhaps a fall. On the other hand, constipation raises the risk of toilet falls by causing a person to struggle for a bowel movement. As a result, this might cause a reduction in heart rate and an increase or decrease in blood pressure, leading to dizziness and falls. Constipation puts physical strain on the bladder, resulting in urine incontinence. This can lead to falls when a person hurries to the restroom or stumbles on pee that has been spilled.

How to manage the falls

Although there are no pharmacological or surgical treatments for Parkinson's-related falls, certain steps that persons with P.D. may take to be aware of and reduce their risk of falls are a common consequence of Parkinson's disease; therefore, avoiding them is crucial. While there are numerous things you can do to decrease your risk of falling, the two most essential are to work with your doctor to ensure that your medications are effective and to see a physical therapist who can evaluate your walking and balance (Palfi et al., 2018). When prescribing assistance devices or exercises to promote safety, the physical therapist is the expert. Although recurring falls are a significant concern for persons with Parkinson's disease, the breadth of the problem and the risk factors for them are not well recognized. Previous studies on falls in persons with Parkinson's disease focused on the general extent of the problem and the risk factors. However, gaining a better knowledge of recurrent falls, in particular, is the first step toward creating effective treatments to prevent and manage them.

Exercise is critical in keeping a person with Parkinson's disease healthy and able to engage in everyday activities (Hobson et al., 2018). Exercises that mainly test and develop a person's balance, reduce axial stiffness, and increase flexibility are great for lowering the chance of falling. They aid in the maintenance of postural stability and mobility, which are essential for avoiding falls. Exercise also improves a person's knowledge of where their centre of mass is located, which can help with balance. Home modifications may help to avoid falls. Adequate lighting and contrasting wall colours, as well as patterns to follow in floor tiles or carpets, may all assist (Hobson et al., 2018) . Getting rid of glare and clutter, which can be both distracting and dangerous, might also assist. Non-skid surfaces and grab bars in the restroom can help decrease the danger of falling. A stable chair can make getting in and out of the bath and bed simpler. Low mattresses and raised toilets also assist to reduce injury.

A healthcare expert can assist a person in determining if medicines, physical conditions, stress, or environmental dangers contribute to their risk of falling. Any gait and balance abnormalities must be detected and interpreted correctly before therapy can be planned. The healthcare team can use the Berg Balance Scale to assess balance (Palfi et al., 2018). Finally, a person's existing drug regimen may need to be reviewed and tweaked. When it comes to falls, the rule of thumb is that 'less is more.' An optimal strategy involves cautious titration (small modifications in drug doses and dosing timing) to optimize a person's function.

Conclusion

Living with Parkinson's disease necessitates fall avoidance. A person with Parkinson's disease can reduce their risk of falling and improve their quality of life by talking to their healthcare team, exercising, and making their house safer. There is an increasing trend in neurological conditions with rising deaths due to mismanagement (Gupta et al., 2018). People with these conditions have the lowest health-related quality of life. These neurological conditions carry a significant burden on individuals, families, careers, and society. Parkinson's diseases are a long-term neurological condition that results from brain damage and is common among the elderly. Risk factors vary from age, sex, genetics, and environmental factors; however, genetics is not an independent risk factor and causes P.D. when combined with environmental factors (Hobson et al., 2018). It results in complications such as thinking difficulties, depression, swallowing problems, and sleep problems and, when left unmanaged, can lead to fatalities such as death and deterioration of brain functions. These consequences have been managed by efforts put in place by NHS, which have commissioned themselves to building capacities that support primary care and planning in Parkinson's disease care.

References

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Darweesh, S.K., Raphael, K.G., Brundin, P., Matthews, H., Wyse, R.K., Chen, H. and Bloem, B.R., 2018. Parkinson matters. Journal of Parkinson's disease, 8(4), pp.495-498.

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