Establishing a business case for joint geriatrician and neurology assessments in an outpatient Movement Disorders clinic

Introduction:

At our Trust a single Parkinson’s Specialist nurse manages a caseload of around 900 outpatients living with Parkinson’s in conjunction with a team of consultant neurologists. It is estimated around 60% of patients living with Parkinson’s will fall each year and patients living with Parkinson’s are known to be at higher risk of osteoporosis and osteopenia. A proportion of these patients will be living with frailty. In order to reduce harm, manage frailty and reduce unplanned hospital admissions we would suggest a more holistic assessment from a geriatrician may be beneficial for a proportion of the outpatients seen in Parkinson’s clinics.

Method:

Using clinic letters, two months of nurse-led movement disorder appointment were audited to establish if any of the following have been documented or discussed:

• Lasting Power of Attorney (LPA) arrangements

• Advanced directive or advanced care plans (ACPs)

• Bone health assessments

• Falls assessments

Results:

74 patients were reviewed in Parkinson’s nurse clinic and after exclusion criteria was reviewed, 41 patients were included in this review of which, 25 had a virtually calculated CFS of 5 or more with a mean age of 75 years.

Unplanned admissions within the past 6 months were noted in 20% (n=5) of the clinic patients. A discussion regarding LPoA and ACP was documented with 12% (n=3) and 8% (n=2) of patient’s respectively. A total of 88% (n=22) of patient’s had a documented falls screening question asked but only 24% (n=6) had a bone health assessment discussed.

Conclusion:

These results demonstrate a gap in the holistic care for older patient’s living with Parkinson’s disease and frailty.  The addition of a geriatrician with specific medical knowledge to optimise frailty, bone health, falls risk and advanced care planning would address the current gaps in holistic care and likely be cost efficient.