Parkinson's disease

Abstract This paper examines the impact of Parkinson’s disease on elderly (65+ years of age) Caucasian males. This is an underserved population in the U.S. 1% of all elderly persons suffer from Parkinson’s and 60% of them are of this underserved population. The paper discusses risk factors that may lead to the onset of this disease but recognizes that the etiology of Parkinson’s is still as of yet unknown.

It examines some of the most common health issues of this population and identifies existing barriers to care. The key factors and social determinants of health of this population are discussed and health policies and advocacy groups, such as the Michael J. Fox Foundation are examined in terms of what they bring to the discussion about regulating control and prevention of the disease.

Finally, recommendations for improving existing programs and interventions for this population are identified, including: the need to increase access to care by promoting the use of telemedicine, the need to focus on the impact that nutrition can have on preventing the disease, and the need to develop better interventions such as physical therapy, speech therapy and occupational therapy.

Keywords: parkinson’s elderly, parkinson’s Caucasian male elderly, preventing parkinson’s disease Population The population used for this study is elderly Caucasian males—white men over the age of 65. Approximately 60,000 Americans are diagnosed with Parkinson’s disease every year (Kowal, Dall, Chakrabarti, Storm & Jain, 2013). Almost 60% of these cases are amongst the elderly Caucasian male population (Dahodwala et al., 2009). The total number of patients suffering from Parkinson’s in the U.S.

was estimated at 630,000 in 2010, but the prevalence of the disease is expected to double by the year 2040 based on the rising trend of cases over the recent years (Kowal et al., 2013). While the cause of Parkinson’s is unknown, the basic factors that contribute to the disease—the death of dopamine producing cells in the brain which leads to a loss of bodily control—is sufficiently understood to at least provide some possible treatments. A cure, however, has not yet been produced.

Risk factors include genetic makeup and environmental variables—and though it is not clear how the two work together it is believed that some connection between genes and one’s environment prompts the death of dopamine producing cells in the brain and triggers the onset of Parkinson’s. McCormack et al. (2002) have suggested with evidence that Parkinson’s is related to exposure to toxic pesticides that are commonly released into the environment, such as the herbicide paraquat.

The results of their experiments with paraquat on in substantia nigra pars compacta showed a connection between the effect of pesticides on the brain and the characteristics of the onset of Parkinson’s. Satake et al. (2009) have identified genomic factors related to the onset of Parkinson’s, suggesting that it is possibly an inherited disease.

Most Prevalent Health Issues The most common and prevalent health issues in the elderly (over 65 years of age) Caucasian male population are: 1) arthritis, 2) heart disease, 3) cancer, 4) respiratory disease, 5) Alzheimer’s, 6) osteoporosis, and 7) diabetes. Other health issues for this population include falls, pneumonia, obesity and depression (Jaul & Barron, 2017). Some of this health issues can be related to the onset of Parkinson’s—such as falls and depression (Farombi, Owolabi & Ogunniyi, 2016; Frisina, Borod, Foldi & Tenenbaum, 2008).

Parkinson’s impacts 1% of the 65+ population, while approximately 10 times as many people suffer from arthritis. Parkinson’s disease impacts a high number of people but it is not as common as some of most prevalent problems that the elderly white male population suffers from. Arthritis, heart disease, cancer, respiratory disease and Alzheimer’s are among the most common.

Existing Access and Barriers to Health Care and Treatment Options Treatment for this population can include a range of interventions, including medications such as dopamine promoters, antidepressants, anti-tremor drugs and cognition-enhancing medication. Self-care practices are also commonly used as a treatment, such as the use of a physical exercise program. Specialist medicine is also an option with neurologists and primary care providers offering suggestions determined on a case-by-case basis and the particular issues and symptoms that appear for each patient.

As not every patient responds the same way to treatment and some may be impacted by correlating symptoms such as depression and anxiety while others may not be impacted by them, care providers have to assess patients individually. Access to care for individuals with Parkinson’s disease, however, is very much based on the support network of the individual and may also be impacted by the individual’s socio-economic status. This is true for the elderly white male population as for any other population as well.

As Parkinson’s disease is something that places the individual at a disadvantage in terms of mobility, the individual must typically rely on some form of support to seek treatment, whether that support comes from family, friends, or neighbors in a retirement community.

Access to care is available for those of the elderly white male population who seek it—however, barriers do also exist, depending on the extent to which the elderly white male is isolated, lives in a poor community or is too far from a facility that provides health care, or the extent to which the individual has not support network to rely upon for assistance, communication, transportation, help with treatment and so on. As Dobkin et al.

(2013) point out, Parkinson’s “is frequently complicated by co-occurring psychiatric problems, such as depression and anxiety, that negatively affect the course and management of the illness” (p. 105). However, the co-morbidity is rarely addressed or treated by health care providers. Instead, they focus only on the Parkinson’s problem and not on any of the attendant issues that may be related, such as issues of falling, anxiety and depression (Dobkin et al., 2013).

One of the barriers to proper care, therefore, is negligence on the part of the health care community to properly provide a holistic approach to the treatment of patients with Parkinson’s. The main reason health care providers fail to provide holistic care is that they simply do not recognize the symptoms of mental health issues that correlate with Parkinson’s disease (Dobkin et al., 2013). Another barrier is distance and time.

Elderly white male patients suffering from Parkinson’s do not always have the means to travel to receive care, both because of the distance between themselves and a health care facility and the time that is required to make that trip. Elderly patients can tire frequently and become exhausted just making small trips. The need for multiple rests throughout the day can complicate any plans to receive care on a routine basis (Dorsey et al., 2013).

Telemedicine is one way the care providers can help patients suffering from Parkinson’s to overcome obstacles of distance and time (Dorsey et al., 2013). The Michael J. Fox Foundation (2018) also advocates for the promotion of telemedicine to help bring the type of care that patients need to those who cannot physically overcome the obstacles of time and space to receive that care.

Telemedicine is described as “the remote delivery of health care services and clinical information using telecommunications technology, including internet, cellular, wireless, satellite and telephone services” (Michael J. Fox Foundation, 2018). By using the technology available today, health care providers can reach the patients of tomorrow—including the elderly white male population. Other access to care options for this population includes accessing government benefits such as Social Security, Medicaid, and disability services.

This population may be able to apply for government aid for obtaining health care; however, Social Security is not as reliable as it once was, and Medicaid, too, has its limitations in terms of the extent of options one can obtain. In short, access to care is available—but it is also limited and not as full as it could be.

Key Factors/Social Determinants of Health Contributing to Overall Health Status of This Population Key factors of health contributing to the overall health status of this population include lifestyle choices—such as diet, exercise, whether one drinks or smokes or abuses drugs; environmental factors such as community, socio-economic background, exposure to pollution or other toxins like pesticides over a prolonged period of time; and genetics, family medical history background.

Members of the population who maintain healthy, organic diets and regularly exercise throughout their lives have fewer problems in their elder years than those of the population who neglect to maintain a healthy diet and exercise regularly (Rowe & Khan, 1997).

Key social determinants of health that contribute to the overall health status of this population include the extent to which the population is underserved, isolated, and neglected; the extent to which the population has a stable and strong support system; the extent to which the population has friends, family or loved ones who visit and provide social contact for the population, and the extent to which the population is able to participate in the community, go to events, take part in social functions, such as clubs, church activities, tourism or family outings.

Health Policies and Advocacy Regulating Control and Prevention of the Disease One of the more famous celebrities to suffer from Parkinson’s is Michael J. Fox. He established the Michael J. Fox Foundation (2018), which “advocates for government policies that accelerate the development of Parkinson's therapies and increase quality of life for patients, families and care partners.” As the Foundation notes, a bill was in Congress that would have expanded Medicare to include telemedicine care, but the bill failed to be ratified.

This shows that there is still a great deal of work to be done in Congress before health care providers can fully utilize all the tools available to them in the Digital Age to treat patients like those in this population. Advocacy actions taken to control and prevent the spread of the disease are not as common because there is as of yet no known cause of Parkinson’s. The Michael J.

Fox Foundation (2018) promotes the role of good nutrition in combating, controlling and preventing Parkinson’s—but there is no solid evidence indicating that a healthy or nutritious diet alone can prevent Parkinson’s from developing. However, a recent study by Seidl, Santiago, Bilyk and Potashkin (2014) showed that “the role nutrition plays in both neuroprotection and neurodegeneration” may be substantial (p. 36). By drawing attention to this new finding, the Michael J.

Fox Foundation has been able to shed light on new developments in research and breakthrough studies that may point the way towards finally understanding what causes Parkinson’s disease in the first place and potentially find ways to stop it. Prior to the attention that Michael J. Fox and his foundation have brought to the issue of Parkinson’s disease, there was little public awareness of it.

The disease itself is not one that has attracted a great deal of attention in the way of advocacy, which is why the Michael J. Fox Foundation is one of the most prominent advocacy organizations in the nation seeking to draw attention to the disease and to raise awareness about options that patients have and so on.

The Foundation has done a great deal just to bring focus to the subject and get researchers and other organizations interested in finding ways to prevent and/or control the disease that impacts approximately 1% of the 65+ population, the majority of whom are white Caucasian males.

The needs of this population, moreover, have been discussed by researchers who have published documents in peer reviewed journals, such as the review by Kleiner-Fisman, Gryfe and Naglie (2013), which showed that this population can benefit from various non-pharmacological interventions, such as speech therapy, occupational therapy, and physical therapy as ways of improving their quality of life. Kleiner-Fisman et al. (2013) noted that there are many different ways to “delay functional decline” in Parkinson’s disease patients.

Their document shows that the various forms of therapy can help substantially to control the negative effects and symptoms of Parkinson’s disease in this population. Hatano, Kubo, Shimo, Nishioka and Hattori (2009) identified the unmet needs of this population after surveying more than 100 patients with the disease. They published their findings in a peer-reviewed study entitled “Unmet Needs of Patients with Parkinson’s Disease: Interview Survey of Patients and Caregivers.” Like Kleiner-Fisman et al. (2013), Hatano et al.

(2009) noted that this population could benefit from better treatment focusing on improving motor skills. They also noted that there needs to be better communication between Parkinson’s patients and their primary care givers. This need could be met by the spread of the use of telemedicine, as the Michael J. Fox Foundation has advocated for, but Congress has not supported the measure in terms of allowing taxpayer dollars to subsidize the application of telemedicine.

This, unfortunately, means that a line of communication that could be utilized to bring physicians and the population closer together is not being used as well as it could. In other words, the Digital Age and its technological advancements is not being put to good use by the medical community because of delays in Congress regarding whether or not Medicare should fund the application of telemedicine.

Recommendations for Improving Existing Programs and Interventions Recommendations for improving existing programs and interventions should be based on the needs of the population identified in this paper, the issues identified by researchers who have published documents on ways to help control and possibly prevent the onset of the disease, and ways to help promote better access to care so that the population can overcome the time and space obstacles that prevent patients from meeting with primary care physicians.

Each of these aspects serves as an area where improvement could be sought. Each therefore can be assessed individually in some degree of detail. Improving Interventions that Address the Needs of the Population To better address the needs of the population, interventions that focus on providing better physical therapy, speech therapy and occupational therapy should be developed by health care providers. These interventions would focus on the physical and motor skill development of the population to prevent functional decline from setting in.

The benefit of development in these types of interventions is that it would reduce dependency on pharmacological interventions, which can have negative side effects, such as increased anxiety or depression. Physical therapy, on the other hand, can improve functional, increase activity and confidence, and provide the patient with a level of self-empowerment that could not be obtained otherwise.

Focusing on Nutrition Ways of controlling and preventing Parkinson’s in this population do not have to focus solely on methods that impact 65+ year olds, but can instead target younger populations as well and focus on promoting healthy, nutritious diets that do not lead to neurodegenerative disorders. Nutrition has been shown as a possible way forward in the research on Parkinson’s.

Therefore, it stands that more attention be given the subject and more clinical trials and longitudinal studies be conducted to determine the exact impact that nutrients can have on the brain. Promoting Telemedicine Increasing access to care for this population can be difficult, but the Digital Age provides a great opportunity for care to be obtained more easily than ever before. Telemedicine is the solution that Parkinson’s patients in this population have been asking for.

It allows them to meet with primary care providers without leaving the safety and comfort of their own home and completely removes the time and space obstacles that have previously prevented this population from accessing care. In order to promote the use of telemedicine in treating.