The presence of a caregiver is associated with patient outcomes in patients with Parkinson's disease and atypical parkinsonisms.

INTRODUCTION: Approximately 88% of men and 79% of women with Parkinson's disease (PD) identify an informal caregiver. Although caregivers can play a key role in supporting patients, little is known about how and whether PD patients with and without caregivers differ in terms of physical, cognitive, and mood outcomes. This study explored whether caregiver presence was associated with variations in patient presentation and outcomes in a palliative PD and atypical PD population. METHODS: Secondary data on individuals with PD and their caregivers came from baseline data of a 3-site randomized controlled trial of outpatient palliative care for PD in the US and Canada. Measures included: MDS UPDRS III, Montreal Cognitive Assessment, quality of life (QOL) measures, depression, prolonged grief, spirituality (FACIT SP-12) and Palliative Performance Scale. RESULTS: Of 210 participants, 175 (83%) had a caregiver. Patients with caregivers had greater motor difficulty, lower cognitive scores, and greater palliative needs as measured by the Palliative Performance Scale. Despite poorer cognitive and motor function, those with caregivers had higher QOL as measured by the Quality of Life in Alzheimer Disease and less spiritual distress. There were no group differences on anxiety, depression, or grief. Caregiver presence moderated the association between lower MoCA score and worse motor symptoms. CONCLUSION: Findings of the present study highlight the influence of caregiver engagement on PD patient outcomes. These findings have implications for clinical practice and suggest that presence of a caregiver may be an important modifying variable on patient outcomes to examine in future research.

Correlates of spiritual wellbeing in persons living with Parkinson disease.

BACKGROUND: Spirituality influences chronic disease coping skills through both positive and negative means. Although previous research notes similar associations between faith and Parkinson disease (PD) management, little is known about spirituality in the context of PD management in a palliative setting. The purpose of this paper is to gain a better understanding of the association between spirituality and PD management to best maximize the effect of spiritual counseling in treatment of the disease. METHODS: This is a cross-sectional analysis of the baseline data of a larger randomized, controlled trial. Individuals with PD and their caregivers were recruited from three study sites with currently-operating outpatient movement disorders and palliative care programs. Correlations were conducted between FACIT total scores and subscales with hypothesized associative factors, such as quality of life (QOL), mood and cognition, advance care planning, and physical symptoms. RESULTS: Two-hundred and ten PD patients and 175 caregivers participated in the study. FACIT scores correlated positively with older age, existence of a caregiver, and involvement in support groups. Higher spirituality was associated with less impairment in QOL, lower anxiety, lower depression, fewer non-motor symptoms, reduced palliative symptoms, and less prolonged grief. There was no significant association between patient FACIT scores and the MDS UPDRS or MoCA scores. CONCLUSIONS: These results highlight the influences of spirituality in PD management and further support the holistic, interdisciplinary care provided to PD patients through palliative care teams offering chaplaincy support to patients.

Depressive symptomology management and falls among middle aged and older adults.

OBJECTIVES: This study aims to examine the relationship between middle-aged and older adults' depressive symptomology and anti-depressant use and the frequency of falls within the previous 12 months, controlling for sociodemographic variables, health indicators, and health behaviors. METHOD: From the 2010 National Social Life, Health, and Aging Project, 2338 cases were examined. Falls were categorized into a binary variable, comparing zero falls with one or more falls. An unadjusted model was run to examine the relationship between independent and dependent variables. Potential covariates were added into the model, and backward elimination was used among independent variables with a univariate P < 0.05 to identify the covariates with the strongest association with falls. This final adjusted binary logistic regression model was then used to examine the relationship between falls and the independent variables. RESULTS: In the adjusted model, anti-depressant use was positively associated with falls (P = 0.001), as was being female (P < 0.001), having diabetes (P = 0.018), and having increased limitations in daily activities (P < 0.001). The relationship between depressive symptomology and anti-depressant prescription was also significantly associated with falls (P = 0.006). CONCLUSION: While findings confirm that a relationship between depressive symptomology and anti-depressant use are associated with falls among middle-aged and older adults, additional studies are needed that simultaneously examine the influence of these two risk factors.

Complexities of fall prevention in clinical settings: a commentary.

Falls and associated injury and mortality are of increasing concern among aging Americans. Effective fall risk management is a complicated process requiring involvement by both health care professionals and older adults for three related actions: (a) early screening to detect risk factors; (b) prescription of tailored interventions; and (c) implementation of, adherence to, and compliance with the intervention by the older adult. Early detection of fall risk can prevent future falls; however, uptake of evidence-based screening and assessment protocols in the clinical setting has been limited. A variety of practice guidelines and financial incentives are available to health care professionals to facilitate adoption. Yet, there remains a gap between recommended practices and current clinical activities. This commentary addresses the complexities of fall prevention practices and offers solutions that can facilitate adoption by clinical practices. Toward this end, this commentary will present two models (i.e., a clinical approach and a financial incentive approach) to summarize current clinical recommendations and practice guidelines for fall risk management in clinical settings. The various drivers to encourage adoption of evidence-based fall risk management strategies will be described. In this context, we will discuss how understanding the different system wide practice improvement initiatives and factors that drive action in physician groups, can facilitate adoption and implementation of fall risk management behaviors by clinicians. Additional efforts are needed to explore and assess similar initiatives to adopt and implement fall risk management practices at different entry points into the system (e.g., community settings, patients, caregivers).