Objective: To identify the prognostic outcomes of patients with Parkinson’s disease (PD) when they are unable to take their oral medication and are medicated via transdermal route or via nasogastric tube (NGT).

Background: Frail, elderly patients presenting to hospital present a challenge to the system due to their multi-morbidities. Cognitive disorders are prevalent in many of these patients and delirium is common consequence of being in hospital or as a result or of their presentation. These delirium spells can result in non-compliance with their acute treatment or regular medication.

Even in the absence of delirium, many patients with PD or Parkinsonism lose their ability to swallow in stressor events like infection, acute heart failure or post-operatively.

Optimisation of the management of PD is dependent on compliance with medication. Missing time-critical medication due to unavailability, non-compliance or compromised swallow can worsen the patient’s prognosis and outcome.

The alternatives for oral Parkinson’s medication are either via NGT or transdermal route.

Method: In this study, the outcomes of patients who were unable to tolerate oral medication and were put onto NG regime or transdermal alternative was collected.

The patients were all ≥65 years, had a length of stay ≥5 days and had a new or pre-existing diagnosis of PD or Parkinsonism on established Levodopa medication regime.

Results: A total of 126 patients were collected.

Of these, 24 were put onto transdermal patch and 13 had a NGT in-situ.

Of the 126, 14 passed away during their admission of which 13 were patients on transdermal regime and 5 of these 13 were NGT and transdermal regime.

The remaining 89 patients were compliant with oral regime or were not put onto transdermal patch or NGT.

Conclusion: Patients with PD have limited endogenous reserve of dopamine and with a rapid withdrawal or delay in medication, can lead to a drop in their dopaminergic stimulation causing dysphagia.

54% of patients on transdermal patches and 38% of those with NGT passed away during their admission which highlights that PD patients losing their swallow is a poor prognostic indicator.

Therefore, the take home message is that any patient with PD or Parkinsonism who loses their swallow should have an Advanced Care Plan and all those involved in the care of these patients should recognise this as a poor prognostic indicator and ensure holistic and personalised care be a priority.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/identifying-the-prognostic-outcomes-of-parkinsons-patients-with-impaired-swallow/