Lifestyle Modifications for Individuals with Parkinson’s Disease

Health Teaching: Lifestyle Modifications for Individuals with Parkinson’s Disease

Nursing narrative notes are incomplete without a quality patient teaching. If the patient has Parkinson’s disease, nurses can teach them and the caregivers about lifestyle changes which will help the patient cope with Parkinson’s better. Below are some of the lifestyle modifications commonly suggested for patients with Parkinson’s diseases. Nurses can use this teaching as a patient education example to complete the nursing narrative note as also educate the patient and caregiver. Lifestyle changes for individuals with Parkinson’s disease include:

1. Exercise helps to reduce rigidity and improve ease of movement in individuals with Parkinson’s. Individuals with Parkinson’s disease must observe compliance with daily exercise schedule. Do not over do on the exercise recommended to a point that it leads to exhaustion and fatigue. Check with your physician or therapist regarding recommendations and limitations for your daily exercise schedule. Observe compliance with recommendations made and limitations suggested. If the symptoms are severely incapacitating, starting with a 5-minutes exercise plan and slowly extending it to the recommended duration in a step-wise fashion, over a period of time, can be helpful.
2. Observe compliance with prescribed anti-parkinsonian drugs, if any. Carefully watch for the symptoms of Parkinson’s such as, difficulty initiating movement, rigidity, and tremor and their response to treatment. Report to your physician regarding poorly controlled or worsening symptoms of the disease, for any needed changes to be made in the treatment plan.
3. Falls and accidents can be frequent in Parkinson’s patients due to the rigidity, impaired coordination, and difficulty initiating movements. Observe compliance with the general fall precautions and use of assistive devices, as recommended, for fall & accident prevention. Having a seat attached to the assistive device, as appropriate, can help with taking a break for rest during ambulation, as needed. During the night, leave your assistive device by your bedside for an easy reach. This can help pick them up on a restroom trip easily.
4. Parkinson’s patients could present with sudden episodes of difficulty initiating a movement, which is called freezing. This random inability to move can compromise balance and result in falls & accidents. Providing some extra stimulus to the lower extremities can help overcome a freezing episode. Having a companion during walking, shifting of body weight from frozen leg to the other, or listening to a favorite beat during walking and stepping to the beat can help overcome a freezing episode.
5. The assistive devices used could be equipped with laser, which acts as a guide for ambulation, by forming a line to step onto. This can help overcome a freezing episode and contribute to fall prevention.
6. Parkinson’s patients, secondary to rigidity involving the hands and fingers can have difficulty with making a firm grip. This prevents the individual to form a firm grip on the handles of assistive devices, such as, cane and walker, which can contribute to enhanced fall risk. Assistive devices with large handles, padded or foam handles can offer better grip for such individuals. Make sure the height of the device is appropriately adjusted to the user.
7. Parkinson’s patients with grossly impaired speech can seek caregiver assistance for interpretation and communication. Minimizing background distractions in the environment of Parkinson’s patients can be helpful. Seeking speech therapy intervention can help with conserving energy, reducing fatigue, and using nonverbal communication skills. Speech therapist can also help with considering use of augmentative and alternative communication (AAC) devices and techniques to enhance the ability of communication.
8. Use furniture of appropriate height, to help an easy lift up, while standing. This also helps maintain stability, while transitioning from standing to sitting position. Having armrests on the furniture also helps stability during sitting and standing up. The seat of the chair must be at least 2 inches higher than the back of the knee, to promote comfort and safety. Using some firm blankets on the chair seat can help elevate the seat to the desired level.
9. Rigidity and difficulty initiating movement in Parkinson’s patients can lead to poor balance and compromised safety. Rearranging shelves in the bedroom, closets, kitchen, and refrigerator with items that are used regularly put in the upper shelves, to help an easy reach. Avoid using the lower shelves, as it needs them to bend to access them. Also, avoid placing items so high that they need to stretch heavily to reach out to them. Severe stretching and bending too low can further compromise balance in Parkinson’s patients, leading to falls. Using long handle reacher can help pick or reach out to items located too low or too high.
10. Parkinson’s patients with incapacitating tremors involving the hands and fingers can have difficulty with performing fine movements of the hands employed during activities, such as, buttoning of shirt, tying the shoelace etc., Using shirts with zipper and slip-on shoes can help save effort in buttoning the shirt and tying the shoelace. Using a long-handled shoehorn to help an easy slip into the shoes.
11. Rigidity and tremors in hands and fingers can incapacitate the Parkinson’s patient with the use of regular toiletries, such as, toothbrush, hairbrush, and razors. Using electrical items can help reduce effort and save energy for the individual.
12. The dressing stick can be used to put on and remove the pants off without bending much, as bending down during these tasks could impair balance and compromise safety of the individual with Parkinson’s. While putting the pant on, be comfortably seated and put the dressing stick in through one leg opening to hold it wide open and put one leg in first. The dressing stick could then be inserted into the second leg opening to hold it wide open and put the second leg in. Then, you can pull the pants a little up the knee, stand straight up and pull the pants into place. While remove the pants off, loosen the pant at the waist while in standing position and drop the pant down below the knee. Then, be comfortably seated and put the dressing stick through one leg opening to hold it wide open and pull one leg out first. The dressing stick could then be inserted into the second leg opening to hold it wide open and pull the second leg out too.
13. Wear clothing with pockets to carry essential items, such as, telephone, personal alert systems. They come in handy to call for help during emergencies and falls. Also, carrying the essential items in the pockets will leave the hands to hold the assistive device and other supportive structures firmly to avoid falls.
14. Using sock aid can help put the sock on and prevent bending down to put it on. Pull the sock onto the sock aid until the toe end, with the heel on the bottom and have the foot in. Using the strings attached to the sock aid, pull the sock aid out, which leaves the sock on your foot.
15. Using a dressing stick can help pull the sock off the foot and prevent bending down. Insert the dressing stick between your leg and the sock on the side of your leg, slide the stick slowly to the back of the leg, and push it off of the back of the heel.
16. Difficulty initiating movement and rigidity in the extremities of Parkinson’s patients can lead to compromised balance. Shoes with pointed heels can compromise the balance further in these patients and promote risk for falls & accidents. Observing compliance with wearing flats can promote safety & security in Parkinson’s patients.
17. Make sure the bed is not too low, as rigidity in Parkinson’s patients can make it difficult to sit on and lift up from. Having a raised bed surface can help promote comfort with use. Make sure the feet are comfortably landing on the floor when seated at bedside. Using a half siderail on the bed can offer good support with easy rolling and getting out of bed.
18. Using sock aid can help put the sock on and prevent bending down to put it on. Pull the sock onto the sock aid until the toe end, with the heel on the bottom and have the foot in. Using the strings attached to the sock aid, pull the sock aid out, which leaves the sock on your foot.
19. Using a dressing stick can help pull the sock off the foot and prevent bending down. Insert the dressing stick between your leg and the sock on the side of your leg, slide the stick slowly to the back of the leg, and push it off of the back of the heel.
20. Difficulty initiating movement and rigidity in the extremities of Parkinson’s patients can lead to compromised balance. Shoes with pointed heels can compromise the balance further in these patients and promote risk for falls & accidents. Observing compliance with wearing flats can promote safety & security in Parkinson’s patients.
21. Make sure the bed is not too low, as rigidity in Parkinson’s patients can make it difficult to sit on and lift up from. Having a raised bed surface can help promote comfort with use. Make sure the feet are comfortably landing on the floor when seated at bedside. Using a half siderail on the bed can offer good support with easy rolling and getting out of bed.
22. Poor grips in individuals with Parkinson’s can often make the task of holding cup, pen, and pencil challenging. Use of adaptive equipment, such as, silicone stretchy cuffs can help promote the grip and reduce the stress of work for the individual.
23. Individuals with Parkinson’s disease can present with slowed reaction time and rigidity of movement. Also, advanced age of senior citizens can add further to slowing the reaction time and compromise safety. Using microwave for cooking and avoiding use of electric/gas burners can help prevent burn injuries and accidents. Using dish washer for cleaning can help avoid the stress on the shaking hands.
24. Individuals with rigidity and tremors involving the hands and fingers can have difficulty forming a grip to hold bar or bottles of soap, shampoo & conditioner while taking shower. Using a wall-mounted soap, shampoo and conditioner dispensers with push-buttons can be easier, as it is less stressful on the tremoring hands of Parkinson’s individuals. Also, this avoids the stress of bending down to pick the bar or bottle of soap, in the event of dropping them down.
25. Maintain a calm and relaxing environment in the bedroom. Observe strict compliance with the sleep time. Turn off all radio, television, or laptop an hour before the scheduled sleep time, so that, it offers enough time to prepare for the routine. Avoid having any stimulants such as, coffee, tea, or smoke close to the bedtime.
26. Drink fluids liberally or as recommended during the daytime and wakeful hours. Limit your fluid intake after dinner and during the night, which can help reduce the trips to the restroom during the night. Trips to the restroom can take unduly long and affect the quality of sleep in Parkinson’s patients. Using a urinal or bedside commode during the night can be of additional help.
27. Individuals with poorly controlled Parkinson’s symptoms must plan most of their life on one level in the house. This helps with avoiding the stress of climbing stairs and uneventful falls. Having an elevator installed can be of additional support for Parkinson’s patients in dwellings situated on two or more floors.
28. If an elevator is not possible and climbing stairs is unavoidable, make sure you are holding a cane for support in one hand. Also, having sturdy railings on the stairs offers extra support to the individual going up and down the stairs. Marking the edges of the steps with bright contrasting colored paint or tape can help with safe placement of foot during climbing up and down the stairs. Having the staircase enough lighted can also contribute to fall prevention.
29. Always remember the rule – “Up with the good leg and down with the bad leg” while climbing up and down the stairs. If both legs are equally functional, then it does not matter to use either leg for leading, followed by the other. If the stairs do not accommodate use of the assistive device, have 2 sets of assistive devices for both floors and the stairs.
30. Rigidity and difficulty to initiate movements can often delay the Parkinson’s patient reaching the restroom and consequently, increase risk for incontinence. Wearing disposable adult diapers can help prevent embarrassing situations. Waiting for a few minutes after an act of voiding and trying to void again can help better emptying of the bladder and thereby, prolong the duration for the next restroom trip. This measure can help save energy and prevent fatigue in Parkinson’s patients.
31. Driving promotes an individual’s personal freedom, control, and independence. Rigidity, sudden onset of episodes of freezing, and tremors in Parkinson’s patients can impair their ability for safe driving and increase risk for accidents. Slowed thought process in Parkinson’s patients can impair their ability to react quickly to road hazards, thus impairing quick application of brakes, timely turning of wheel, and slamming on the gas pedal as needed. Also, medications used to treat Parkinson’s disease can induce side-effects such as, dizziness, blurred vision, and confusion. All these factors contribute to compromised safety of the Parkinson’s individual, other passengers in the vehicle, and the general public traveling on the road.  So, limiting driving and seeking caregiver assistance for rides or depending on public transport could be safer options for Parkinson’s patients.
32. Stiffness and rigidity of muscles involving the face and jaw in Parkinson’s patients could progressively lead to difficulties with chewing and safe swallowing. Ability to chew is the major stimulus for saliva production. Difficulty with chewing in Parkinson’s patients can lead to reduced saliva production and consequently result in dry mouth, which can make the swallowing even more difficult. Impaired safe swallowing function can lead to severe complications such as, choking and aspiration pneumonia. Parkinson’s patients with difficulty chewing must seek speech therapy consult for recommendations on safe swallow. Do not rush while eating. Caregivers should provide frequent reminders and encouragement regarding allowing enough time to eat and not rushing through the process, which can contribute to reduced risk of choking and complications. Using smaller size spoons can reduce the volume of food taken in at a time, which can help prevent choking. Caregivers helping to cut the meat into smaller pieces before the patient starts to eat can help reduce the effort for the patient and promote the ease.