Cuidados en casa para el paciente con Parkinson en el Día Mundial

Publication: Popular Science China

Author: Mai Bo

Producer: Guangdong Provincial Association for Science and Technology.

At six in the morning, Mrs. Li woke up again to the moans of her husband, old Zhang. At 68 years old, Zhang has suffered from Parkinson's disease for eight years, and in the past year, his condition has drastically worsened, making it increasingly difficult for him to move. As his sole caregiver, Mrs. Li spends most of her energy each day helping Zhang turn over, get dressed, and eat. But that morning, when Mrs. Li was helping him to the bathroom, Zhang suddenly became rigid and unable to move, and they both fell to the edge of the bed. Mrs. Li scraped her arm, and Zhang's head hit the corner of a piece of furniture, resulting in a fracture of the left femoral neck, which would require surgery. In the emergency room, with red eyes, Mrs. Li murmured repeatedly: "I really don't know how to take care of him..."

This is not an isolated case. According to statistics, the number of Parkinson's disease patients in our country has surpassed 5 million, and the vast majority opt for home care. However, many families, like Aunt Li's, lack scientific methods, resulting in patients suffering additional pain and their relatives becoming physically and mentally exhausted. Associate Professor Pan Qi from the Department of Neurosurgery at Sun Yat-sen Memorial Hospital of Sun Yat-sen University explains that home care for Parkinson's disease patients should focus on the following key points, allowing caregivers to avoid "detours" and improve the quality of life for patients.

Medication management must be precise and timely.

The most commonly used medication for Parkinson's patients is levodopa. The medication schedule directly affects its efficacy, so it should not be changed lightly. In clinical practice, many patients change their medication schedule on their own, resulting in reduced effectiveness and worsening of the "on-off" phenomenon. Family members are advised to help patients set alarms on their mobile phones to take their medication strictly at the scheduled time.

Attention must also be paid to medication details: Foods rich in protein can affect the absorption of levodopa, so it should be taken one hour before meals or one and a half hours after; safinamide should be taken in the afternoon or evening to avoid insomnia; entacapone should be taken in combination with levodopa as it is ineffective alone; and amantadine should be taken before 4 PM, otherwise it may affect sleep.

Modify the home environment to prevent falls.

Patients like Zhang have a high risk of falls due to muscle rigidity and balance disorders. Therefore, when providing home care, the following key modifications to the home environment should be made: install handlebars in the bathroom, lay anti-slip mats, place a raised toilet seat next to the toilet; remove small rugs, thresholds, and clutter from the floor to avoid tripping; install motion-sensor night lights in the bedroom and hallway for nighttime activities; the bed height should allow the patient to have both feet stable on the ground when sitting at the edge, and guardrails or handlebars should be added to the bedside, with bumpers on the edges of furniture.

Caregivers should also learn the correct support technique: position themselves next to the patient, allowing the patient to hold onto their shoulder with one hand, while the caregiver wraps an arm around the patient's waist. Using leg strength instead of waist strength, the caregiver should help the patient move, thereby preventing another fall.

Eating and defecating are "two major problems."

People with Parkinson's disease often experience muscle rigidity in swallowing, which causes swallowing function disorders, as well as persistent constipation due to reduced intestinal motility. When eating, it is important that the patient maintains an upright posture with the chin slightly tucked, avoiding leaning back while swallowing. The amount of food should be limited to half a spoonful at a time, waiting for each bite to be fully swallowed before offering the next. The food texture should preferably be pureed or very soft, avoiding clear liquids (like broths or light porridge) and hard foods (like cookies or nuts). If coughing, voice changes, or difficulty breathing occurs while eating, feeding should be stopped immediately, and if necessary, medical attention should be sought to assess the need for nasogastric tube feeding.

For constipation, it is recommended to drink a glass of warm water on an empty stomach upon waking and perform a clockwise abdominal massage. Family members can include natural foods in the patient's diet that promote bowel movements, such as pureed plums, dragon fruit, and oats. If necessary, mild laxatives can be used under a doctor's guidance.

Psychological care and functional rehabilitation are equally important.

Many people with Parkinson's disease may experience depression, anxiety, and even hallucinations. Caregivers should keep in mind: do not argue, deny, or blame. For example, if the patient is convinced that someone has stolen something from them, it should not be directly said "no one stole, you are mistaken," but rather respond "really? Let's look, it's surely somewhere." At the same time, the psychological adjustment of the caregiver is also very important—the breakdown of Mrs. Li demonstrates that caregivers need to take a "break" regularly. It is suggested to seek help at community day care centers and reserve at least half a day a week to rest.

For the patient's physiological function, engaging in passive activities and active exercises can effectively slow down functional decline. It is recommended to perform passive activities twice a day, in the morning and evening, helping the patient complete movements such as external rotation of the shoulder joint, bending and extending the wrist, and dorsiflexion of the ankle joint; each joint movement should reach its limit but not cause pain. Additionally, patients are encouraged to read aloud to practice speech clarity and use a metronome to assist with starting and walking exercises. When ensuring safety, it is advised that patients continue to engage in a certain amount of outdoor activities and physical exercises, such as walking and tai chi.

It is important to remember that some patients who have undergone deep brain stimulation surgery must follow medical guidelines for their rehabilitation. Older brain pacemakers require patients to take special care in their daily lives, avoiding proximity to objects with magnetic fields, such as microwaves, televisions, and security doors. Currently, new brain pacemakers have almost no impact on patients' daily routines; however, after deep brain stimulation surgery, patients are not recommended to engage in high-impact sports like basketball or badminton, although jogging or tai chi is permitted.

Content provided by: Guangdong Provincial Association for Science and Technology.

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