Experiences of People Living with Parkinson's Disease in Care Homes: A Qualitative Systematic Review.

BACKGROUND: Incidence of disability secondary to Parkinson's disease is increasing faster globally than any other neurological condition. The diverse appearance of symptomatology associated with Parkinson's, and the degenerative nature and subsequent functional decline, often increase dependence on caregivers for assistance with daily living, most commonly within a care home setting. Yet, primary literature and evidence synthesis surrounding these unique and complex care needs, challenges and the lived experiences of this population living in long-term nursing or residential facilities remains sparce. The aim of this review is to synthesize qualitative literature about the lived experience of people with Parkinson's disease living in care home settings. METHODS: A systematic search of the literature was conducted in October 2023 across six different databases (CINAHL, Medline, EMBASE, PsycINFO, Scopus and Cochrane Library). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was used to guide this review. RESULTS: Five articles met the inclusion criteria. Four themes were identified following evidence synthesis: (1) Unique pharmacological challenges. (2) Transitioning and adapting to care home life and routines. (3) Dignified care within care homes. (4) Multidisciplinary care vacuum in care homes. CONCLUSION: This review revealed the significant and unique challenges for people with Parkinson's disease when transitioning into care homes. These are exacerbated by wider social care challenges such as staffing levels, skill mixes and attitudes as well as a lack of disease-specific knowledge surrounding symptomatology and pharmacology. The lack of multi-disciplinary working and risk-adverse practice inhibited person-centred care and autonomy and reduced the quality of life of people living with Parkinson's disease in care homes. Recommendations for practice highlight training gaps, the need for consistent and improved interdisciplinary working and better person-centred assessment and care delivery.

An initial set of reference values for the Balance Tracking System (BTrackS) Limits of Stability protocol.

BACKGROUND: The Balance Tracking System (BTrackS) Limits of Stability (LOS) protocol is a relatively new means of evaluating unconstrained dynamic postural control ability. While the reliability of this protocol has previously been established, reference data is currently unavailable to assist in the interpretation of results. RESEARCH QUESTION: What are typical reference values for the BTrackS LOS protocol with respect to sex, height, and BMI? METHODS: A cross= -section of 800 healthy, young adults (aged 18-29 years; 368 men, 432 women) were administered the BTrackS LOS protocol. Sex, height and weight variables were also captured for the participants. RESULTS: Results of a stepwise linear regression showed that the outcome measure for BTrackS LOS testing (i.e. LOS Area) was larger in taller individuals and in men. Based on these findings, four percentile ranking categories were established and associated look-up tables created. SIGNIFICANCE: The reference values provided by this study offer much needed guidance to clinicians and researchers for the determination of dynamic balance abnormalities based on BTrackS LOS testing.

The role of gender in the association between personality and task priority in older adults' dual-tasking while walking.

BACKGROUND: Falls are a major problem for older adults. Many falls occur when a person's attention is divided between two tasks, such as a dual task (DT) involving walking. Most recently, the role of personality in walking performance was addressed; however, its association with DT performance remains to be determined. METHODS: This cross-sectional study of 73 older, community-dwelling adults explores the association between personality and DT walking and the role of gender in this relationship. Personality was evaluated using the five-factor model. Single-task (ST) and DT assessment of walking-cognitive DT performance comprised a 1-min walking task and an arithmetic task performed separately (ST) and concurrently (DT). Dual-task costs (DTCs), reflecting the proportional difference between ST and DT performance, were also calculated. RESULTS: Gender plays a role in the relationship between personality and DT. Extraversion was negatively associated with DTC-motor for men (ΔR2 = 0.06, p < 0.05). Conscientiousness was positively associated with DTC-cognition for women (ΔR2 = 0.08, p < 0.01). CONCLUSION: These findings may lead to effective personality-based early detection and intervention for fall prevention.

Initial Experience with Renal Denervation for the Treatment of Resistant Hypertension - The Utility of Novel Anesthetics and Metaiodobenzylguanidine Scintigraphy (MIBG).

BACKGROUND: The Symplicity-HTN 3 trial failed to show significant difference in blood pressure (BP) lowering between patients undergoing catheter-based renal denervation (RDN) and the sham-procedure arm of the study. However, there is still optimism about the role of RDN in the treatment of resistant hypertension, because identification of patients with increased sympathetic activity thus being good RDN responders, improvements in the RDN procedure and new technology RDN catheters are all expected to lead to better RDN results. We present our initial experience with RDN for the treatment of resistant hypertension, and the utility of novel anesthetics and cardiac (123)I-metaiodobenzylguanidine scintigraphy ((123)I-MIBG). METHODS AND RESULTS: Seven patients with resistant hypertension underwent RDN and were followed up for 6 months. MIBG was performed before RDN, in order to estimate sympathetic activity and predict the response to RDN. All patients were sedated with dexmedetomidine and remifentanil during RDN. All patients tolerated the procedure well, were hemodynamically stable and their peri-procedural pain was effectively controlled. A median of 7.6 ± 2.1 and 6 ± 1.4 ablations were delivered in the right and left renal artery respectively, making an average of 6.8 burns per artery. No peri-procedural or late complications - adverse events (local or systematic) occurred. At 6 months, mean reduction in office BP was -26.0/-16.3 mmHg (p=0.004/p=0.02), while mean reduction in ambulatory BP was -12.3/-9.2 mmHg (p=0.118/p=0.045). One patient (14.3%) was a non-responder. None of the cardiac (123)I-MIBG imaging indexes(early and late heart-to-mediastinum (H/M) count density ratio, washout rate (WR) of the tracer from the myocardium) were different between responders and non-responders. CONCLUSION: Patients with resistant hypertension who underwent RDN in our department had a significant reduction in BP 6 months after the intervention. (123)I-MIBG was not useful in predicting RDN response. Dexmedetomidine and remifentanil provided sufficient patient comfort during the procedure, allowing an adequate number of ablations per renal artery to be performed, and this could probably lead to improved RDN results.

The costs of taking it slowly: fast and slow movement timing in older age.

We investigated adult age-differences in timing control of fast vs. slow repetitive movements using a dual-task approach. Twenty-two young (M = 24.23 yr) and 22 older adults (M = 66.64 yr) performed three cognitive tasks differing in working memory load and response production demands and they tapped series of 550-ms or 2100-ms target intervals. Single-task timing was comparable in both groups. Dual-task timing was characterized by shortening of produced intervals and increases in drift and variability. Dual-task costs for both cognitive and timing performances were pronounced at slower tapping tempos, an effect exacerbated in older adults. Our findings implicate attention and working memory processes as critical components of slow movement timing and sources of specific challenges thereof for older adults.

Posture and cognition interfere in later adulthood even without concurrent response production.

We investigated adult age differences in dual-task costs in cognitive-sensorimotor settings without concurrent response production and with individually adjusted resource demands for the cognitive task. Twenty-four young adults (M=25.42 years, SD=3.55) and 23 older adults (M=68 years, SD=4.46) performed a cognitive task and two postural control tasks (standing on a stable and moving platform) both separately (single-task context) and concurrently (dual-task context). The cognitive task did not require response production during posture data collection and its difficulty was individually adjusted to 80% correct performance under single-task conditions. Results showed pronounced age differences in postural control in the moving platform condition, which increased further under dual-task conditions. Our findings support the assumption of increased cognitive resource demands for postural control in older adults. They extend existing work by taking two shortcomings of previous studies into account. We discuss cognitive and posture task constraints in this and previous studies as factors determining multi-tasking and its changes in later adulthood.

Dissociations between motor timing, motor coordination, and time perception after the administration of alcohol or caffeine.

RATIONALE: The impacts of psychoactive drugs on timing have usefully informed theories of timing and its substrates. OBJECTIVES: The objectives of the study are to test the effects of alcohol and caffeine on the explicit timing involved in tapping with the implicit timing observed in the coordinated picking up of an object, and with the temporal discrimination. MATERIALS AND METHODS: Participants in the "alcohol" experiment (N = 16) received placebo, "low" (0.12 g/kg or 0.14 g/kg for women/men, respectively) or "high" (0.37 g/kg or 0.42 g/kg, respectively) doses of alcohol, and those in the "caffeine" experiment (N = 16) received placebo, 200 or 400 mg caffeine. Time production variability was measured by repetitive tapping of specified intervals, and sources of variance attributable to central timer processes and peripheral motor implementation were dissociated. The explicit timing in tapping was compared with the implicit timing in the coordinated picking up of an object. Time perception was measured as discrimination thresholds for intervals of similar duration. Drug effects on reaction time were also measured. RESULTS: For tapping, alcohol significantly increased timer variability, but not motor variability; it did not affect coordination timing in the grip-lift task. Conversely, for time perception, the low dose of alcohol improved temporal discrimination. Caffeine produced no effects on any of the timing tasks, despite significantly reducing reaction times. CONCLUSIONS: The effects of alcohol argue against a common clock process underlying time interval perception and production in the range below 1 s. In contrast to reaction time measures, time perception and time production appear relatively insensitive to caffeine.