What is hospitalization

Medical treatment and care received during admission for an overnight stay to a hospital. With advances in outpatient surgery and treatment options such as home health care, hospitalization is becoming increasingly less common. Most often, people with Parkinson’s are hospitalized for other reasons such as surgery, illness, or injury. It is important, yet sometimes challenging, to receive appropriate attention for the aspects of Parkinson’s that hospital staff might not view as relevant to treatment of the condition for which the person is hospitalized. This includes schedules for anti-parkinson’s medications, any special dietary schedules, range of motion exercises, and regular activity such as walking. The higher the level of assistance the person with Parkinson’s requires, the more difficult meeting these needs usually is. This is partly because hospital care typically is narrowly focused on the person’s medical condition and treatment rather than on the person as a whole, and partly because hospital staff generally do not have great depth of knowledge about Parkinson’s disease.

To the extent that it is practical, the person’s neurologist should be in contact with the physician responsible for the person’s care in the hospital (known as the attending physician) to ensure proper consideration of Parkinson’s disease care issues. Some hospitals permit a family member or regular caregiver to administer anti-parkinson’s medications, if the attending physician gives a written order authorizing it. This helps maintain the person’s medication schedule with minimal disruption. Some hospitals do not allow this and require that their personnel administer any and all medications; the policy depends on how the hospital’s view of the potential liability for any errors that might take place. In either case, it is important for the attending physician (and ideally the patient or the caregiver acting in an advocate role) to monitor other medications being given, and to consult with the person’s neurologist when necessary, to make sure they do not interfere with the anti-Parkinson’s medications, including anesthetics and medications for pain relief. If the hospitalization is planned, such as a scheduled surgery, often it is possible to work out with the hospital’s dietitian a meal plan that meets the person’s needs such as protein restrictions, or to supply the foods the person regularly eats. Again, this requires the attending physician’s order.

Being in the hospital can be a frightening experience for the person with Parkinson’s, particularly if he or she experiences fluctuating symptoms and the on-off state that increase dependence on others for routine activities such as toileting or has symptoms that include cognitive dysfunction, memory loss, or dementia. Hospitalization often is disorienting under the best of circumstances. If possible, family members and friends can take turns staying with the person so someone familiar is always there. When the person is released to go home from the hospital, check with the doctor about whether home health care is appropriate. People who return home with wound dressings (such as after surgery), casts for fractured bones, or other medical care needs often qualify for home health care services in which health care professionals such as nurses and physical therapists go to the home to provide medical care.

Typically, a person with Parkinson’s disease is not hospitalized unless there is no other way to provide needed medical treatment. Regardless of the reason for hospitalization, make sure the admitting physician has a copy of the person’s advance directives. In many hospitals this is part of the routine admission procedure. The family member or caregiver who will be spending most time with the person during the hospitalization should have a copy of the advance directives as well, so there are never any questions as to what actions are appropriate should a medical crisis occur.

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