Long-term care of elderly patients with
Parkinson's disease (PD) is challenging for
long-term care staff and physicians. Because the progression of PD varies among patients, an individualized treatment plan, updated as necessary based on
disease progression, comorbid conditions, and side effects, is essential. Education regarding PD management is also needed to provide optimal care, and treatment guidelines from professional associations are available. Especially important is the management of motor complications, which usually emerge
after treatment with antiparkinsonian medications, particularly
levodopa/
carbidopa. Current treatment strategies to avoid or treat motor complications aim at providing a more continuous (ie, physiologic) dopaminergic stimulation, rather than the pulsatile (intermittent) stimulation provided by traditional PD treatments.
Catechol O-methyltransferase (COMT) inhibitors prolong the
levodopa serum half-life and allow more
levodopa to be delivered to the brain over a longer time, thereby smoothing dopaminergic stimulation.
Dopamine agonists also provide more continuous dopaminergic stimulation but are associated with a greater likelihood of
hallucinations and
confusion, especially in the elderly. Treatments that reduce motor complications, allowing a higher level of functioning, lessen the burden of care in
long-term care settings and increase quality of life for patients and their families.