Health Consequences and Management in Scotland UK

Introduction

In elderly, the immune system and central nervous system with progressing age becomes degraded making reduced formation of new cell that can replace the damaged cell and promote healing which results them to develop various neurodegenerative disorder. Parkinson's disease (PD) is one such neurodegenerative disorder that progress with age and affect mostly the elderly above 50 years compared to young in which the central nervous is damaged leading to affect movement and body flexibility of individuals (Sveinbjornsdottir, 2016). In Scotland, UK, it is seen that 1 in every 375 adults are suffering from Parkinson’s disease (Parkinsons, 2018). In 2018, it is reported that more than 1500 people in Scotland are diagnosed with Parkinson’s disease indicating 30 people each week are to be detected with the disease (Parkinsons, 2018). These statistics indicate that there are rising numbers of people in Scotland, UK who are diagnosed with Parkinson's disease. Thus, discussion regarding the key health consequence of PD and its management is required so that effective actions can be taken to control the well-being of the people suffering from the disease in Scotland, UK.

In the UK, only 1,752 of the people under the age of 50 years are affected by PD whereas total of 133,972 people above the age of 60 are affected by the disease (parkinsons.org.uk, 2020). The age specific data for PD cannot be found in relation to Scotland, UK but the overall statistics indicates it mainly affected the elderly and therefore the elderly population would be focused in the study. The lack of effective management of Parkinson’s disease leads the aged individual to experience challenges with mobility, chewing and swallowing, sleep disturbances, urinary problems, constipation, depression and anxiety and others (Tysnes and Storstein, 2017). One of the potential consequences of Parkinson’s disease is negative impact on the nerve cells in deeper parts of the brain known as subustantia nigra (produces dopamine) and basal ganglia (transmits nerve signals with the help of dopamine). The damage in the nerves leads to create hindrance in transmitting messages from the brain to control effective body movement that creates challenges for aged individuals such as bradykinesia, tremor and rigidity to be faced in social and everyday life (Tysnes and Storstein, 2017). Thus, in this essay, the way damage caused by the Parkinson’s disease such as bradykinesia, tremor, rigidity and postural instability which creates challenges for people in making free movement and executing daily activities suffering from the disorder is to be discussed. Moreover, the way holistic healthcare management to be made by nurses in overcoming the challenge created through consequence of Parkinson’s disease is to be discussed.

Assessing and Managing health consequence of Parkinson’s disease from nursing perspective

The people suffering from Parkinson’s disease (PD) face stiffness and rigidity of the limbs, neck or trunk as the key consequence of the disorder. The exact mechanism which leads people to face this consequence is briefly understood and it is informed that association of hindered dopamine release is the key factor for the consequence (Ascherio and Schwarzschild, 2016). As commented by Burbulla et al., (2017), dopamine in the neurotransmitter which is responsible for relaying messages from the brain to the nervous tissues. Thus, it acts to signal the nerves to work appropriately in trunk leading to support effective mobility among individuals. As argued by Tan et al. (2016), in people with Parkinson’s disease, the nerves present in the deeper parts of the brain that is the subustantia nigra and basal ganglia are negatively affected. There is increased number of dopamine-secreting neuron present in the area which on getting negatively affected produces reduced amount of dopamine that leads to hinder flexibility in movement and promote stiffness of muscles.

The rigidity and stiffness of muscles as a consequence of PD contributes to lower mobility range and efficiency of the individual leading to development of bradykinesia which is making extreme slow movement (Chagdes et al., 2016). It leads them to face difficulty in making turns over bed or chairs, move around place to execute everyday activities, trouble writing, walking, running and others. As asserted by Gunnery et al. (2017), muscle stiffness in Parkinson's disease leads the patient to experience challenge of face masking. The face masking in PD is the condition in which people fail to show expression on their face according to situation as their facial muscles become immobilised or stiffened. As asserted by Chumacero et al. (2018), consequence of muscle rigidity in Parkinson’s disease creates difficulty for the individual to deliver meaningful speech and maintain swallowing. This is because the nerves controlling the muscles for forming speech and allowing swallowing becomes stiffened in the people suffering from the neurodegenerative disorder. As argued by Ma et al. (2019), facial masking and speech deformity in PD creates challenges in communication with the patient by the nurses. This is because the nurses during communication with the patient deduce by looking at the facial expression and understanding speech of the patient regarding their moods and level of satisfaction of care. However, face masking or hypomimia along with speech deformity in PD creates difficulty for nurses in understanding emotions and moods of the patients to determine willingness and satisfaction in receiving care, in turn, making it difficult for them to make accurate care decision for the patients (Argaud et al., 2018).

The study by Bologna et al. (2018) mentions that rigidity of the muscles as a result of Parkinson's disease creates the challenge of bradykinesia in patients in which the movement of the individuals are extremely slowed. The stiffness also contributes to create challenge of sleeping for the person suffering from Parkinson's disorder. This is because poor mobility leads individual to face hardship in falling asleep and stays at awake at night (Frisaldi et al., 2017). Thus, the evidence indicates that lack of control of rigidity or stiffness of muscles as a consequence of Parkinson’s disease would create variety of social and physical challenges for the patients which deteriorates their well-being and quality of life.

On the basis of presence of additional symptoms of Parkinson other than rigidity and muscle stiffness, the health profession try to diagnose presence and extent of spread of the disease among individuals (Pagano et al., 2017). The positron emission tomography (PET) is being currently used to diagnose stiffness and rigidity in Parkinson's disease. This is because through PET the presynaptic dopamine terminal functionality can be examined by measuring the dopamine transporter (DAT), amino acid decarboxylase (AADC) and vesicular monoamine transporter (VMAT2) density (Mathar et al., 2017). Thus, the PET analysis helps to determine to what dopamine is released in the body and the way it is influencing muscle rigidity contributing to develop mobility challenges for the person suffering from Parkinson’s disease.

The nurses can implement various interventions in managing muscle stiffness or rigidity in people suffering from Parkinson’s disease (PD), in turn, acting to control health challenges created out of the consequence of the disease. As asserted by Voon et al. (2017), muscle stiffness in people with Parkinson's disease is usually managed by the nurses through administration of levodopa with carbidopa for the patients. The combination of the two medications is found to be intensely effective in treatment and management of muscle stiffness in PD. This is because carbidopa act as decarboxylase inhibitor preventing the breakdown of levodopa before reaching the blood-brain-barrier (BBB) (Senek et al., 2017). The combination of two medications are mostly given to PD patients as cardidopa assist to prevent nausea caused out of only administering levodopa (Senek et al., 2017) According to Chang et al., (2016), degeneration in the subusntia nigra causes disruption of nigrostriatal pathway leading to lower dopamine levels. This condition contributes towards muscles stiffness in PD. As argued by Ray Chaudhuri et al., (2019), levopoda which are precursors to dopamine has the ability to cross the blood-brain-barrier (BBB). This leads them to get converted in the peripheral and central nervous system into dopamine, which in turn, creates adequate neurotransmitter to be present n the body to send signals from the brain to nerves to effectively perform their actions in supporting mobility. Thus, the combination of the medication is to be used by patients to be able to cope with all the social and physical challenges that could be otherwise faced due to muscle stiffness or rigidity. The levodopa and carbidopa are self-administered orally by the patients or administered by the nurses (Wirdefeldt et al., 2016).

The study by Antonini et al. (2018) informs that use of levodopa as medication for PD leads to create side-effects such as dyskinesia in which people experience involuntary abnormal tremors. In contrast, the study by Fernandez et al. (2018) mentions that levodopa and carbidopa side effects in treatment of stiffness in PD lead to constipation, dizziness, loss of appetite and others. In order to avoid side-effect of medication, the nurse to ensure holistic management of muscle stiffness in patients with PD refers to the patients allow access to physiotherapy services. As mentioned by Ashburn et al. (2019), nurses by collaborating with the physiotherapy experts ensure delivering physical therapy with no side-effects in managing muscle stiffness created due to PD. This is because physiotherapist mainly performs physical massage for different condition faced by PD patients to improve movement and functional capability of the PD patients such as walking, transferring balance and others (Barboza et al., 2019).

The presence of muscles stiffness among patients with Parkinson’s disease (PD) is considered to be painful as they are unable to freely move in performing their daily activities with ease (Sveinbjornsdottir, 2016). As asserted by Kessler and Liddy (2017), self-help techniques to manage muscle rigidity in PD include performance of physical exercise and maintain own mobility. This can be executed by patients with active training and knowledge from the nurses and physiotherapist. As argued by Duncan et al., (2018), nurses avoiding working with physiotherapist in educating patients regarding physical therapy often face hindrance in performing their role of delivering care. This is because the physiotherapist is expert in performing and educating patients regarding physical methods such as exercises, heat and cold therapy and others. Thus, in case of managing muscle stiffness to improve quality of life for PD patients, the nurses are required to work in collaboration with physiotherapist. This is to educate patients regarding the exercises they are to perform to maintain their enhanced mobility and avoid rigidity that creates challenges in their everyday life.

In managing muscle stiffness or rigidity among patients with PD, that leads the individual to face challenges with movement, balance, sleep and others the nurses could refer them to avail care through complementary therapies. In the study by Khuzema et al., (2020), it is mentioned that contemporary therapies such as yoga and Tai-Chi are effective in overcoming muscle stiffness to allow enhanced mobility among older adults with Parkinson’s disease. The study mentions in Tai-Chi individuals with PD are made to stress weight lift and sway ankle beyond their limit to engage in relaxing their muscles. This, in turn, contributes to enhanced neuromuscular rehabilitation promoting enhanced flexibility and mobility among people with PD. Moreover, yoga helps to enhance the non-motor and motor ability of individuals suffering from PD, in turn, promoting them avoid facing challenges of movement in social life out of their health condition (Ni et al., 2016). In support to the facts, the study Ni et al., (2016) also mentions the power yoga is helpful in lowering muscle stiffness and improving mobility and additional challenges due to be consequence of Parkinson’s disease (PD). This is evident as significant improvement in upper and lower movement of limbs among the 26 patients with PD who involved in power yoga was seen. Moreover, the 3-month yoga program in the study led the researcher to ensure that bradykinesia that is a challenge raised as a consequence of muscle stiffness among PD patients was considerably lowered making the patients show enhanced muscle strength for movement.

Conclusion

The above discussion informs that Parkinson’s disease (PD) one of the key neurodegenerative disease faced by older individuals with progressing age compared to young in the UK. One of the key consequences of PD is stiffness or rigidity of muscles in patients which leads the individuals to experience challenges with movement, sleeping, balancing, develop bradykinesia and others.

The nurses to manage the consequence of muscle stiffness and avoid the challenges with PD orally administer patients the combination of levodopa and carbidopa medications. This is because carbidopa helps levodopa which is precursor of dopamine to overcome blood-brain-barrier to support production of adequate dopamine in the body leading to avoid muscle rigidity out of hindered neuron signals. The nurse also allows self-help techniques to be adopted by PD patient with muscle stiffness so that they can personally manage to control their movement and avoid being burden of care on others. The nurses refer PD patients with muscle stiffness to avail physiotherapy and contemporary therapies like yoga, Tai-Chi and others to enhance flexibility of their muscles without having any side-effects that are faced by individuals on availing medication in controlling PD.

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