Introduction
It is well known that people suffering from chronic diseases have major impact in the healthcare delivery systems, including the elderly population over the age of 65. With the advances in technology combined with the aging population, more people are living longer with chronic diseases. Longer life expectancies count for higher costs in healthcare for the treatment, management and prevention of further complications arising from chronic diseases. The third most common chronic disease of the older adults is Parkinson’s disease. It is a debilitating disease affecting a person’s motor ability, causing tremors, rigidity, akinesia or slow movement, and postural instability. According to the National Institutes of Health, about 500, 000 individuals in the United States suffer from Parkinson’s Disease, and it is estimated that males are more often affected than females. Parkinson’s disease has a large economic impact and directly affects medical costs, as well as the affecting the person financially, such as lost wages and decreased productivity. According to a recent interview with a client suffering from PD over the course of ten years, the disability directly impacted his personal life, financial status, and family members. The next discussion talks about how the patient learned about his disease and the personal impact it created at the beginning of the disease process until the peak onset later in his life.
How the patient learned about his disease
During the interview with the 65 year old male client, who was recently hospitalized for shortness of breath and worsening peripheral edema, the wife also gave a brief history on how the disease was discovered. The patient currently lives at home with his wife as the caretaker and the mother of two young adults. According to the recent studies, signs and symptoms typically begin between 40 and 70 years of age with a peak onset in the 60’s. In the client’s case, the beginning of his disease manifestation fell within the normal range identified. During the interview, the patient stated that the early signs and symptoms of the disease, such as fatigue, slight resting tremors of the hands, and problems with manual dexterity, began in his early 50’s. In addition, the wife had noticed uncontrollable tremors on one side of the patient’s upper extremities that lasted from 1-5 minutes while at rest. Early during the disease process, the patient noticed slight muscle rigidity and tremors occurring on one side of his lower extremity while ambulating. The gait abnormality was also noticeable by family members and friends. Muscle rigidity was noticed early in the disease process and progressed over time. In the client’s case, the disease was left undiagnosed until the symptoms became progressive enough to interfere with daily activities and a healthcare provider was needed for medical consult and intervention.
During that time, there were no specific studies to diagnose PD, and the only measure left to confirm the patient’s disease was to administer antiparkinsonian drugs until the symptoms improved. After several blood test, diagnostic studies, and medication administration of antipakinsonian drugs to control physical manisfestations of the disease, the patient was finally diagnosed with Parkinson’s disease when the symptoms improved. Drug therapy is the essential part of management, which decreases signs and symptoms and allows the client to provide self-care and have a reasonable quality of life, (Ignatavicius & Workman, 2006). During the progression of the client’s diagnosis, several healthcare specialists, including the physician, physical therapist, speech language pathologist, registered nurses, and social workers developed interventions to educate the client and his caretaker about disease management and possible long-term effects of the disabling condition. Educational experience of the patient while learning about his chronic disease is the next topic.
Educational experience of the patient while learning about his chronic disease
The differences are vast between caring for a person with an acute illness on a short term basis, and caring for those over the “long haul” with a chronic condition (Larsin & Lubkin, 2009). Families and caregivers can sometimes become overwhelmed because of the life-long interventions involved with caring for the client with chronic diseases. Therefore, proper training and education of caregivers and the client should be one of the main focuses of healthcare providers to prevent further complications, such as falls and aspiration, from the disease. During the interview session with the patient and caregiver, a multidisciplinary team of healthcare workers were involved with the care. Visiting nurses perform routine home visits to ensure the client and the caregiver was properly counseled on medication adherence, side effects, adequate diet, home safety, fall prevention, and follow visits with the primary care provider and consultants.
The educational experience provided by the team of healthcare workers greatly enhanced both the client and caregiver’s knowledge of the disease process, provided emotional support for the family, and increased compliance with treatment regimen. Over the years after the initial diagnosis of Parkinson’s disease, the patient developed other chronic healthcare problems, including CHF and dementia, requiring further interventions, such as fluid restriction and increased assistance with ADLs and transfers . As a result, the caregiver was the introduced to the use of hoyer lift, which adds to the positive educational experience provided for the management of this worsening chronic disease. Through client and family education, there was a significant reduction in the hospital re-admission of the client, and social worker visits helped alleviate some stress and role strain experienced by the primary caregiver. Dealing with Parkinson’s disease not only affected the client’s caregiver and immediate family members; the disease also made a significant impact on the client’s social, financial, and personal life.
Social, financial, and personal effects of client living with Parkinson’s disease
As a result of impaired cognitive function and memory deficits in clients suffering from Parkinson’s disease, social interaction can be a challenge on a daily basis. In the late stages of the disease there is a major impairment in mobility function, articulation, and the client has a tendency to drool. Clients often avoid social situations or group events that would embarrass them. In the case of the 65 year old male client, the same situation developed causing social isolation and depression. Aside from the social effects of the disease process, the client suffered a tremendous decline in financial standing. Before the onset of the disease, the client worked 40-48 hours a week as a mechanic and a taxi cab driver. He valued hard work and was the main provider for the family until the early signs and symptoms of the debilitating disease forced him to apply for disability in his mid 50’s. Through government assistance programs, including SSI, Medicaid, and Social service consultations, the client and his family were assisted financially. The social and financial impact of the disease also caused personal grief. One of the major personal effect the client experienced during the progression of the disease was depression. At one point during the severe manifestation of symptoms, the client admitted that he had lost all hope of becoming better again and the disease fully controlled his everyday existence. He asked God to end his years of suffering from the disease, and tears rolled down his eyes. The loss of control in his life created feelings of helplessness; therefore it is essential to educate the patient about support groups to help maintain a positive self-esteem and cope with the chronic illness. Change motivators were used in this situation to address the readiness of the client to alter the negative self-concept caused by his chronic condition.
Change motivators the patient used and why change had not occurred Motivation is defined as the forces acting on or within an organism that initiate, direct,

and maintain behavior. In the teaching-learning situation, motivation addresses the willingness of

the learner to embrace learning (Redman, 2007). The client’s motivation and readiness to learn

played a big role in his ability to learn and manage the chronic condition. In addition, the

client’s personality and outlook in life also affected his motivation for change. According to the

caregiver, the client had a pessimistic view in life and was resistant to change prior to suffering

from his illness. The client suffered from depression and anxiety during the course of the disease

that made him unwilling to receive and participate in health promoting behaviors to improve his

condition. Those who believe they will not be able to cope well dwell on their personal

deficiencies and imagine that potential difficulties will be more formidable than they really are

(Redman, 2007).

Conclusion

Parkinson’s disease is a progressive terminal disease that has no cure at this time.

Therefore the evaluation of nursing interventions should focus on maintenance of function and

engagement in activities for as long as possible. Having a chronic disease can greatly affect a

person’s social, financial, and personal life. A multidisciplinary team of healthcare workers are

needed to assist clients to maintain physical function and safety at home. Providing education to

clients and their family members based on motivational theories are important to determine the

success rate or failure of the educational materials given.Participation of family members in the

continued care and rehabilitation is essential for the maintenance and client support during the

disease process.

References

Ignatavicius, D. D., & Workman, L. M. (2009). Medical surgical nursing: Critical thinking for

collaborative care (5th ed.). St. Louis, MO: Mosby Elsevier.

Larsen, P.D. & Lubkin, I.M. (2009). Chronic illness: Impact and intervention (7th ed.). Sudbury,

MA: Jones and Bartlett

Redman, B. (2007). The practice of patient education: A case study approach (10th ed.). St.

Louis, MO: Mosby Elsevier.