Finding ways to make Parkinson’s hospital care more ‘age friendly’
Parkinson's Foundation outlines new measures to help older patients
- The Parkinson's Foundation is aiming to improve hospital care in the U.S. for older people with the chronic disease.
- Hospitalized Parkinson's patients face risks like delirium, worsening motor symptoms, and aspiration pneumonia.
- The CMS' Age-Friendly Hospital Measure provides 'tactical recommendations' for healthcare centers.
The Parkinson’s Foundation has published a new journal article outlining a practical pathway for making hospital care more age friendly for older people living with Parkinson’s disease.
The work aims to translate — into everyday practices — the Age-Friendly Hospital Measure set forth by the Centers for Medicare & Medicaid Services (CMS), a U.S. government agency that provides health coverage to more than 100 million Americans. The CMS’s widely used framework aims to reduce preventable harm and provide high-quality care to older adults and to those living with chronic diseases such as Parkinson’s.
“As the CMS Age-Friendly Hospital Measure takes hold and our population continues to age, hospitals and health systems are embracing the age-friendly movement to deliver safer and better care for older adults,” Sneha Mantri, MD, Parkinson’s Foundation’s chief medical officer, said in a press release from the nonprofit detailing the “tactical recommendations” outlined in the article.
“The Parkinson’s Foundation seeks to harness this momentum to ensure people with [Parkinson’s disease] receive the best care possible,” Mantri said.
Titled “Advancing Parkinson’s Care and Patient Safety Through CMS’s Age-Friendly Hospital Measure,” the article was published in The Joint Commission Journal on Quality and Patient Safety.
Parkinson’s is the second-most common neurological disorder globally, with 1.1 million people in the U.S. estimated to live with Parkinson’s, and more than 10 million worldwide.
There’s an increased risk of harm for Parkinson’s patients when hospitalized
People with chronic conditions such as Parkinson’s, and older Americans in general, face an increased risk of preventable harm when hospitalized, the article notes. Issues that can arise during hospitalizations include worsening of motor symptoms, delirium — a mental state of confusion, disorientation, cognitive difficulties, and reduced awareness — and death due to aspiration pneumonia, a type of lung infection that occurs when food or liquids enter the lungs, which may be associated with difficulty swallowing or changes in mental health status and awareness.
These risks may be even higher for financially disadvantaged patients and those who belong to racial and ethnic minorities or live in isolated communities, data has shown.
The Age-Friendly Hospital Measure requires medical centers participating in Medicare’s Hospital Inpatient Quality Reporting Program to follow the 4Ms Framework for Age-Friendly Care, a set of four evidence-based elements for high-quality care. Effective Jan. 1 of this year, hospitals that don’t comply with the program risk a 29% reduction of their Medicare payment update.
The 4Ms include aligning care to each patient’s healthcare goals and preferences, dubbed “What Matters”; using medication that doesn’t interfere with healthcare goals, mobility, or mental health, cited as “Medication”; preventing and managing dementia, depression, and delirium, or “Mentation”; and ensuring patients move safely to maintain function, cited as “Mobility.”
The Parkinson’s Foundation had previously published hospital care recommendations related to medication management. These urged adherence to patients’ at-home regimens, measures to improve mobility, and screening for difficulty swallowing to reduce the risk of aspiration pneumonia.
Based on the 4Ms and the Parkinson’s Foundation’s Hospital Care Recommendations, released in 2023, the study proposes enhancing the age-friendly health system to deliver quality care to people with the neurodegenerative disease.
Implementing the 4Ms: Medication, Mentation, Mobility, and What Matters
Regarding healthcare goals, patients and caregivers should be asked about their healthcare objectives and urged to share how their disease diagnosis, symptoms, and treatments affect their lives. Hospitals should then develop plans to address patients’ goals and challenges.
Hospitals should also align medication schedules with patients’ at-home medication regimens and implement measures to reduce medication delays, such as prioritizing Parkinson’s patients in medication administration or making use of automated dispensing cabinets. Measures to avoid the administration of inappropriate and contraindicated medications for people with Parkinson’s and unnecessary medication substitutions should also be taken, per the article.
Hospitals are seeking disease-specific playbooks to better protect and meet the complex needs of older adults. This paper offers one for [Parkinson’s].
Additionally, hospitals should provide patients with opportunities for safe mobilization, if appropriate, three times a day, and establish protocols to screen for swallowing issues. Cases of social vulnerability, including social isolation, financial issues, limited access to healthcare, and risk of mistreatment, should be identified and addressed through appropriate intervention strategies.
“The 4Ms define what great care looks like for older adults,” said Peter Pronovost, MD, PhD, lead author of the study and chief quality and transformation officer at University Hospitals Cleveland Medical Center. “The Parkinson’s Foundation Hospital Care Recommendations show clinicians how to deliver [these measures] reliably for people with [Parkinson’s] in real hospital workflows.”
Pronovost said “hospitals are seeking disease-specific playbooks to better protect and meet the complex needs of older adults. This paper offers one for [Parkinson’s].”
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