Impact of Health Inequalities on Parkinsons Disease Patient

Impact of health Inequalities on Parkinsons Disease PatientIn the de bring startment of wellness semipublication from Vision to Reality (2001), the minister for public wellness, Yvette Cooper, and the chief medical officer, Professor Liam Donaldson, stated the sp ar-time activityAt the arising of 21st century, your chances of a wellnessy life stable depend on what job you do, where you live, and how much your p arnts earn. This is unfair and unjust. That is why this Government is committed to constraining the health inequalities that scar our nation and to improved health for entirely.How does this argument support the elderly with Parkinson complaint in Bromley trust Kent?IntroductionThe focussing of this lodge study is to explore the health inequalities which affect a specialised sort within Bromley community. This group has been defined as those suffering with Parkinsons unsoundness, a chronic trail that tends to affect an old knob group and shadow in any cas e be associated with obscure medical lacks. This test entrust define and explore the concept of inequalities in health, define the distemper ad its effects on community as their families, and relate these to a community in the Kent ara served by Bromley NHS Trust.The other aim of this essay is to look at solutions and interventions which might address near of the health inequalities and challenges posed by this grouchy condition and its prevalence within the community. The books assigns to the specialised health problems and challenges of this lymph gland group, and at that place is political sympathies and governance literature which specifically addresses their needs. However, it come out of the closets there is still a deficit between the needs of clients, which are complex and fractious to address, and the level of provision in health and mixer attending run, which lodge to be down the stairs-resourced and less(prenominal) than ideally designed.Parkinsons DiseaseParkinsons is a progressive neurological ailment which occurs as the result of the loss of middle cells in the substantia nigra in the maven (PDS, 2007). The lack of these cells results in a lack of dopamine, a substance that allows messages to be sent to the parts of the brain that bidding movement (PDS, 2007). When approximately 80% of dopamine is lost, symptoms start to develop, and levels track to depress over time, causing symptoms to increase (PDS, 2007). Two proposed causes are hereditary disorders and environmental toxins (PDS, 2007), although a be adrift of other associations continue to be explored. No real cause is kn deliver, and there is no kn have cure, although some medications wad mediate the course of the disease and help in symptom control (PDS, 2007). Motor symptoms of Parkinsons are tremor, bradykinesia and stiffness of muscle builders, while non- ride symptoms include quietus disturbance, cons periodation, depression and urinary urgency (PDS, 2007). Fatigue is a nonher symptom (Lloyd, 1999). It is self-explanatory from this extend of symptoms that martyrs may need an increasing range of health and cordial support go and interventions during the progression of the disease.One epidemiological review puts the post of Parkinsons disease in the UK cosmos at 19 per chiliad per year, with a lifetime prevalence of 2 per 1000 mickle (MacDonald et al, 2000). The Parkinsons Disease Society (PDS, 2007) state that one in 500 people in the UK suffers from the disease. This would suggest a considerable burden on topical anesthetic health and genial distri unlesse serve in any local anaestheticity. However, there is also the lie with that such(prenominal) statistics often only represent the tip of the iceberg (MacDonald et al, 2000). There may be a greater summate who have not yet been diagnosed or who do not onrush shot services and so are not counted in surveys. The age range of sufferers of Parkinsons disease is 40-90 years, with the greatest proportion in the 70-74 age group, and the conterminous highest rate in the 74-79 age group (MacDonald et al, 2000). This is obviously an age-associated condition.The Bromley Health service NHS Trust provides an outpatient Parkinsons clinic run by Dr B Kessel as part of the elderly medicine directorate (www.bromleyhospitals.nhs.uk, 2007). There is also the Joint apportionment panel which the elderly medicine team contri simplye to in providing complex home care packages. Therefore, it would await that for this locality, there is some specializer Parkinsons disease provision. However, there are no figures to describe the uptake and get on health and social services from Parkinsons disease sufferers. For example, the look at on community treat services, social care services, nursing homes, fasting services, primary health services and pharmacy services.Parkinsons disease is commonly treated by drug treatments which aim to redress the loss of dop amine (Pentland, 1999). Levodopa-containing agents replace dopamine within the body, while dopamine agonists mimic the litigate of dopamine (Pentland, 1999). Enzyme inhibitors can be used, which prevent dopamine breakdown, and anticholinergics can reduce the action of acetylcholine which can also improve symptoms (Pentland, 1999). There is ongoing struggle and review of the risk-benefit ratio of these treatments but they have been shown to be utile in limiting symptoms (PDS, 2007 Pentland, 1999). other(a) pharmacological interventions may be utilised to reduce specific symptoms, such as hypnotics for insomnia, antidepressants for confirmed depression, and pain killers and quinine for pain and muscle cramps (Pentland, 1999). Hoever, achieving and maintaining the correct, legal drug regimen as the condition progresses can be problematic for client and medical team (Lloyd, 1999).Health InequalitiesIt was in 1998 that health ine woodland reduction became express aims of the NHS in the UK, with the publication of A depression Class table service (DH, 1998). Since then, inequalities in health have remained on government and health service agendas. The National Service Framework for Older flock (DH, 2001) sets out a number of standards to address key inequalities in health experienced by the subject group concerned in this essay. The circumstance that such standards have had to be set is evidence of demonstrable inequalities united to these areas.To begin with, inequalities are link up to age. It has been shown that in some health and social care services, ripened people and their carers have been victims of age-based discrimination in attack to services and availability of services (DH, 2001). The locality here, Bromley Trust in Kent, does not advertise specialiser Parkinsons disease services explicitly on their website, and so sufferers of this condition fall under the aegis of elderly care services and also neurology services (trust ref). However, res ourcing for such services may not be optimum, with less resources perhaps given to less quaint areas of health need (DH, 2001), but rather to the much fashionable and topical areas such as childrens and pubic louse services. There are veritable areas of need which could be viewed as common to older peoples services and specific to those with Parkinsons disease, such as community equipment (DH, 2001). some other specific inequality for this client group is entre to mitigatory care services, with many palliative care services only available to cancer sufferers (DH, 2001). Parkinsons disease is a degenerative and ultimately terminal condition, and as such should be a defining condition for palliative care. However, palliative care services in some areas may be funded by cancer charities such as Macmillan Cancer care, which may pose a challenge. This leads to a policy issue which could only be addressed at policy management level within the local trusts. The burden on family and u npaid carers is considerable, and increases with the progression of the disease (Lloyd, 1999). This leads to further lead on services out-of-pocket to carer- associate unsoundnesses (Lloyd, 1999). Again, unequalized admission price to services, here based on the condition and the lack of support for those affected by it, continues to exist.The issue of inequality related to ethnic minority or background (DH, 2001) may also be applicable here, as the locality does contain a range of divers(prenominal) minority ethnic groups. However, the demographics are not available to explore the rank of Parkinsons disease across the different ethnic minorities in the region.The literature does highlight one specific incidence of health inequality in relation to this disease. It appears that sufferers who are hospitalized do not have timely access to their medications due to the restrictions of ward rounds and nursing routines (Agnew, 2006). Another inequality is in access to community care estimations which provide the intense levels of care and support infallible as the disease progresses (Lloyd, 1999). Not only do Parkinsons disease sufferers suffer from a relative difficulty in accessing and obtaining such assessments, the assessment provides only a partial picture when exploring to what extent the health and social care needs of people with Parkinsons are being assessed (Lloyd, 1999). The assessments are apparently predominantly medical, failing to address the other range of needs, peculiarly social and emotional issues and every mean solar day living needs such as personal care (Lloyd, 1999). As these assessments are generally not carried out in the persons own home, they are inadequate in providing a true picture of the realities of the disease in individual(a)ist cases (Lloyd, 1999).The more general subject of health inequalities highlights a range of factors which might adversely affect the health and wellbeing of this client group. Poor health is linked to social background factors (Iphofen, 2003). The Bromley community area encompasses a all-encompassing range of socio-economic groups, from those deemed to be in poverty through the middle classes to the affluent classes. investigate has demonstrated that those low down on the social class pecking order tend to have worse housing, poor nutritional status, are less fit and are more likely to engage in prejudicious or risky health behaviours (Iphofen, 2003). It is logical that these people are the well-nigh likely to become ill, die sooner, or be some in need of health and social care input and support (Iphofen, 2003). otherwise factors which may affect health inequalities include culture, gender and ethnicity (Iphofen, 2003).It is also serious to consider the role of individual action and self-reliance (Iphofen, 2003), which may come out at odds with accredited political trends towards nanny state policies which are in danger of labelling vulnerable groups and individuals as being to blame for their own ill-health. One example of this is the smoking ban, which has been legislated on the back a festering trend of refusing medical treatment to sufferers of smoking-related conditions until they have given up smoking. A similar trend appears to be occurring for obese and over encumbrance individuals, but it would seem that this form of discrimination, whilst socially and morally wrong, is politically sanctioned.Health Problems related to Parkinsons Disease.As can be seen from the literature, there are a wide range of health problems which affect Parkinsons sufferers, primarily related to the disease and its symptoms and their affects on health and independence. Parkinsons is a long term illness (Rhind, 2007 Kristjanson et al, 2006) and as such will require long term nursing and social support, surveillance and review. Parkinsons disease causes physical disability, and affects all of the activities of cursory living by restricting independence, self-rel iance and self care (PDS, 2007). It can affect peoples ability to maintain relationships, carry on in employment and leisure activities, and to continue to live on their own in their own home, or with their families (PDS, 2007). Lloyd (1999) also highlights the fact that Parkinsons disease is socially unacceptable and this can have ongoing effects for the sufferer and their carers.One of the problems associated with the disease is dysphagia, the softness to swallow or difficulty in swallowing (Miller et al, 2006). Dysphagia can have obvious physical effects, such as choking, and inability to access proper nutrition or maintain healthy weight (Miller et al, 2006 Lorefalt et al, 2006). It can also have social and mental effects, such as embarrassment and depression, withdrawal from social eating situations and effects on family and carers (Miller et al, 2006). give-and-take for dysphagia is limited, and so the condition can lead to long term alterations in nutritional state leading to interventions such as total parenteral nutrition (Miller et al, 2006 Lorefalt et al, 2006).Another associated set of symptoms are psychological symptoms. These can vary, but can present as depression, sleep, confusion and delirium, hallucinations and dementia (Nazarko, 2005). These can be challenging conditions to treat, and may require a mixture of support, psychiatric intervention, pharmacological intervention and sedation, and family/carer support (Nazarko, 2005). Such symptoms represent a considerable demand on quick services, and as yet, there are no specialiser psychiatric services for this client group within the locality under discussion.Addressing Health Inequalities by Condition ManagementThe Department of Health (2001) stresses the following are necessity to combat the continued inequalities experienced by the older age group in accessing services and support an integrated begin between local authorities and health services strong clinical and managerial leadership service user and carer representation at every level working parties and management groups which continually address and review the situation. Other actions include workforce development (DH, 2001), and there may be a greater need for training and awareness-raising, particularly with nursing staff. Nursing staff need to listen more to Parkinsons sufferers when providing care (Agnew, 2006).Another issue is the proper assessment of older peoples conditions (DH, 2001), which is important as Parkinsons disease can present as one of a complex range of multiple diseases or conditions. Modern management of Parkinsons disease (PD) aims to obtain symptom control, to reduce clinical disability, and to improve quality of life (Pacchetti et al, 2000). Specific instruments or tools may be necessary as part of the assessment process (Heffernan and Jenkinson, 2005).The National Institute for Health and clinical Excellece (NICE, 2006) make the following recommendations people with suspected Parki nsons disease should be seen by a specialist within six weeks new referrals with later on progress of disease should be seen within two weeks there should be regular, ongoing review of the condition sufferers should be empowered to participate in their care and all people with Parkinsons should have regular access to specialist nursing care to provide monitoring and adjustment of medication, a point of contact for support including home visits and a reliable source of instruction about clinical and social matters relevant to Parkinsons disease. There is a need to access and engage with psychiatric services due to the long-term psychological and emotional effects of the disease (Lloyd, 1999). NICE (2006) argue strongly for specialist nurses and multidisciplinary clinics, which would be appropriate given the complex presentation of the disease. This comprehensive onslaught would go a long way to reducing the inequalities experienced by this age group. However, the local services in Bromley may not be currently resourced adequately to meet such targets.Other interventions might also include speech therapy, physiotherapy, occupational therapy and of course palliative care services (Carter, 2006). The local trust has service provision in all these areas, and all but the last can be demonstrated to be involved in the care of clients with Parkinsons disease in Bromley. However, it might be that more provision and more targeted provision might be necessary to reduce the inequalities suffered by this client group. Some literature suggests the use of complementary therapies such as massage to support those with the condition (Patterson et al, 2005). Other therapies such as music therapy might be appropriate (Pachetti et al, 2000). euphony as a therapy acts as a specific stimulus to obtain motor and emotional responses by combining movement and stimulation of different centripetal pathways (Pacchetti et al, 2000). In a prospective, randomised controlled trial, musi c therapy was found to be effective on motor, affective, and behavioral functions, and as such would be a sound addition to therapy programmes for people with Parkinsons disease (Pacchetti et al, 2000).One example of lucky care management has been described by Holloway (2006), who reports in the implementation of a care pathway to meet specific needs. The pathway is user-led, conceptualising the user/carer as the communications centre, resourced and supported in the management of their situation by the professionals to come upon their own integrated package of care (Holloway, 2006). This pathway takes into account individual disease presentation, social factors, severity of illness and degree of use of services (Holloway, 2006). The research showed this pathway to be feasible for implementation within standard, existing clinics and was well received by clients and carers (Holloway, 2006). Another programme which has demonstrated some success and positive outcomes is a club for pa tients and their carers at a day hospital in Bridlington (Nasar and Bankar, 2006). The multidisciplinary team use the club for patient assessment, gentility and disease management, while it also provides the patients and carers with a forum for discussion and an chance for social interaction (Nasar and Bankar, 2006).Another important aspect of reducing health inequalities is in developing alliances with service users and engaging with specific groups who are socially excluded (Watterson, 2003). It may be that the reason that Parkinsons sufferers feel so excluded is due to nurses perceptions of them as less than cognitively competent, due to prejudices about the temperament of the disease. Service users have important and often critical knowledge and experience about their lives, condition, symptoms and responses to treatment (Watterson, 2003), which could greatly enhance both policy planning and direction and individual care planning and ongoing disease management. There are cha llenges associated with attempting such engagement, and even further policy and procedure planning, with associated resource input, would be needed to ensure accessibility, effective communication and responsiveness.ConclusionAs has been demonstrated, sufferers of Parkinsons disease, itself a complex aetiology, presentation and progression, have a range of specific and challenging needs which are not being met by the local services in Bromley. While some services exist, there are other models of care, management, assessment and monitoring which have been demonstrated to be effective in other localities, which may be appropriate for this specific client group. Services need to be client centred and comprehensive, utilising tools and guidelines developed specifically for the disease and its symptoms. Services must also be multi-disciplinary, multi-agency and also holistic. However, the provision of such services may not be practical within the current NHS climate. With the direction s et out in government and NICE documents, however, it would appear that the drive to improve such services will go ahead.This essay addresses a very small, confined client group with a specific disease presentation. However the scope of health inequalities across the whole population may be much wider and more disturbing. It would appear that there is a need for targeted programmes to tackle health inequalities in almost every service, but if these can be addressed in one area, they can be addressed across the whole service to counteract years of unequal access and provision which have continued to fail those in most need.3,000 words.ReferencesAgnew, T. (2006). Nurses out of step with Parkinsons patients. Nursing Older People. 18(6). 8-9Carter, L. (2006) The role of specialist nurses in managing Parkinsons disease. Primary Health circumspection. 16(8). 20-2.Costello, J. Haggart, M. (eds.) (2003) Public Health and Society Basingstoke Palgrave MacmillanDepartment of Health (2001) The National Service Framework for Older People Available from www.dh.gov.uk. Accessed 14-4-07.Heffernan, C. Jenkinson, C. (2005) bill outcomes for neurological disorders a review of disease-specific health status instruments for three degenerative neurological conditions. Chronic Illness. 1(2). pp. 131-42Holloway, M. (2006) Traversing the network a user-led Care Pathway approach to the management of Parkinsons disease in the community Health brotherly Care in the lodge 14 (1), 6373Iphofen, R. (2003) Social and individual factors influencing public health. In Costello, J. Haggart, M. (2003). Public Health and Society Basingstoke Palgrave Macmillan.Kristjanson, L., Aoun, S., Yates, P. (2006) Are substantiative services meeting the needs of Australians with neurodegenerative conditions and their families? Journal of Palliative Care 10 (2).Lloyd, M. (1999) The new community care for people with Parkinsons disease and their carers. In Percival, R. Hobson, P. (eds.) (2003) Parkinson s Disease Studies in psychological and Social Care. London MPG Books Ltd.Lorefalt, B Granerus, A Unosson, M. (2006). Avoidance of solid food in weight losing older patients with Parkinsons disease. Journal of Clinical Nursing 15(11) 1404-12.MacDonald, B.K., Cockerell, O.C., Sander, J.W.A.S. Shorvon, S.D. (2000). The incidence and lifetime prevalence of neurological disorders in a prospective community-based study in the UK. Brain 123 665-676.Miller, N Noble, E Jones, D. (2006) Hard to swallow dysphagia in Parkinsons disease. Age Ageing. 35(6) 614-8.Nasar, M Bankar, R. (2006) meliorate outcome in Parkinsons disease. British Journal of Hospital Medicine. 67(1). pp. 6-7Nazarko, L. (2005) Part 3 psychological effects of Parkinsons disease. Nursing Residential Care. 7(6).261-4.NICE (2006) Draft signpost on Parkinsons Disease Available from www.nice.org.uk Accessed 14-4-07.Pacchetti, C., Mancini, F., Aglieri, R. et al (2000). Active Music Therapy in Parkinsons Disease An Integrative Method for Motor and horny Rehabilitation. Psychosomatic Medicine 62 (3) 386-393.Parkinsons Disease Society http//www.parkinsons.org.uk/ Accessed 14-4-07.Paterson, C Allen, J Browning, M. (2005). A pilot study of therapeutic massage for people with Parkinsons disease the added value of user involvement. Complementary Therapies in Clinical Practice. 11(3). 161-71.Pentland, B. (1999) The nature and course of Parkinsons disease. In Percival, R. Hobson, P. (eds.) (2003) Parkinsons Disease Studies in Psychological and Social Care. London MPG Books Ltd.Percival, R. Hobson, P. (eds.) (2003) Parkinsons Disease Studies in Psychological and Social Care. London MPG Books Ltd.Rhind, G. (2007) Managing Parkinsons disease over the longer term. Independent Nurse. 22 Jan. pp. 18-9Wacker, R.R., Roberto, K.A. Piper, L.E. (1998) Community Resources For Older Adults Programs and Services in an Era of Change London quick of scent Publications, IncWatterson, A. (ed.) (2003) Public Health in Pract ice Basingstoke Palgrave Macmillanhttp//www.bromleyhospitals.nhs.uk/referrers/clinical-services/elderly-medicine/ Accessed 14-4-07.