Parkinson’s disease (PD) is a progressive neurodegenerative disorder, meaning a person’s symptoms and difficulties increase over time often in stages. Those who are caring for loved ones with Parkinson’s should focus on continually adapting not only the home environment but also daily routines. A PD patient’s health and abilities will change as their condition progresses and therefore their care plan should, too. Anticipating and accommodating these changes will help to extend a loved one’s independence for as long as possible and maintain their quality of life.
Improving Home Safety for Parkinson’s Patients
All areas of a PD patient’s home must be adapted to meet their needs and abilities. Various kinds of mobility problems are common symptoms of Parkinson’s disease, therefore home safety and accessibility are high priorities. Since seniors with PD often use canes, walkers, rollators or wheelchairs to facilitate movement, wide, clear pathways in rooms and hallways are important. The following home elements can make it difficult for a person with limited mobility to get around their home safely.
- Floor Coverings
Thick carpets can be more difficult to walk on than thin carpets or bare floors. People with Parkinson’s typically develop a shuffling gait that contributes to an increased risk of tripping and/or falling. It’s best to remove throw rugs, but any remaining accent and area rugs should be placed on nonslip mats and the corners should be taped down or otherwise secured. Bare floors should be cleaned with slip-resistant floor wax.
Floor lamps and table lamps should be placed so that they cannot be tipped over easily. Make sure all light switches are within reach and easy to turn on and off. Tuck away electrical cords so they do not pose a fall risk.
- Furniture Arrangements
Pieces of furniture should be placed far enough apart to enable a senior (and their mobility aid, if applicable) to access all areas of their home. If a PD patient uses a wheelchair, most experts suggest that pieces of furniture be placed roughly 5.5 feet apart, which allows a wheelchair to perform a complete 360-degree turn unhindered.
- Home Decorations
Decorative objects like large floor vases, statuary objects and side tables often prove difficult to navigate around. When possible, remove them or ensure they are placed well out of main walkways.
Room-by-Room Home Modifications for Parkinson’s Disease
Due to increasing difficulties with walking, balance, coordination and adapting to sudden changes, it is important that all furniture throughout the home is stable. Any rolling furniture, such as a bed frame, should have the caster wheels removed or firmly locked in place to prevent accidents. A person with Parkinson’s disease who is confined to a wheelchair or uses another rolling mobility aid like a rollator should always lock the wheels on their devices before attempting transfers in and out of the bed and chairs. A bed rail or safety handle can be installed on a senior’s bed frame to assist with these transfers as well.
The kitchen area needs to be made as accessible and user-friendly as possible for someone suffering from Parkinson’s. Switching out small hardware on cabinets and drawers with larger handles or pulls can allow PD patients with tremors, poor grip strength and limited dexterity easier access to storage areas in the kitchen. (The same concept applies to doorknobs and similar hardware around the house—add bulky grips to knobs or replace them with levered door handles.) Pieces of rope or fabric can also be tied to existing hardware to improve access. Whenever possible, keep cookware, dishes, utensils and pantry items between chest and waist level. This will prevent a senior from reaching up high or stooping over, thereby helping to prevent falls.
A 2011 Centers for Disease Control (CDC) report names bathrooms as one of the most dangerous rooms in the home when it comes to slips and falls. Nonfatal bathroom injuries, such as contusions, abrasions, strains, sprains and fractures, most commonly occur in or around the tub or shower and on or near the toilet. Properly installed grab bars that are screwed into wall studs beside toilets and sinks and inside and outside tub/shower areas can provide PD patients with extra stability and confidence while bathing and toileting. Avoid using removable suction cup grab bars, which aren’t intended to support one’s full body weight and will do very little to help a senior break a fall.
Stepless walk-in showers and walk-in tubs are ideal for seniors with gait disturbances that can make getting in and out of the shower or tub difficult and possibly dangerous. A shower chair or transfer bench can be used over a normal tub to minimize a PD patient’s fall risk. In some cases, caregivers may opt to replace glass shower doors with plastic doors or a shower curtain. Non-skid mats are a smart addition within the bathtub and around the sink and bathtub areas to provide additional traction on often slippery bathroom floors.
Because someone living with Parkinson’s disease may have difficulty grasping objects, it’s best to transition from bar soap to liquid body wash or soap-on-a-rope to prevent it from falling to the floor. In addition, toilet paper, tissues and all other bathing and personal care products should be kept within easy reach in the bathroom.
Simplifying Activities of Daily Living (ADLs) for Parkinson’s Patients
Many aspects of daily life that we take for granted become come increasingly difficult for someone who is living with Parkinson’s. Movement symptoms like weakness, tremor, rigidity, balance problems and bradykinesia (slowness of movement) become especially pronounced in the middle and later stages of the disease. Medications used to treat PD, such as carbidopa-levodopa, dopamine agonists, MAO B inhibitors and anticholinergics, can also have bothersome side effects like dyskinesia (involuntary muscle movement), lightheadedness, drowsiness, hallucinations and confusion that can interfere with daily routines. Fortunately, there are assistive devices and adaptations that can help patients maintain their quality of life and help make caring for someone with Parkinson’s easier for family caregivers.
Bathing and Personal Care Tips
Baths become increasingly difficult as PD progresses, so showers are usually preferred. However, some people with Parkinson’s may eventually experience changes in the brain that affect memory, judgement and focus. The Alzheimer’s Association estimates that 50 to 80 percent of Parkinson’s patients experience these and other symptoms of dementia. Individuals living with Parkinson’s disease dementia and Lewy body dementia (a condition that shares similar symptoms with PD) may benefit from some adaptations, assistive devices and caregiving techniques that are used in dementia care. For example, many dementia patients are confused or even frightened by the sound and feel of running water while showering. If your loved one requires assistance with bathing, be sure to give them time to adapt to the situation and to understand what is happening. Gently talk them through the process, ensure they are warm and comfortable, and start with less sensitive areas of the body, such as the feet and hands, before proceeding to wash other areas.
A Parkinson’s patient may struggle with other personal care tasks like tooth brushing, shaving and hair care as their motor symptoms worsen. However, proper oral hygiene is essential for preventing tooth decay and gum disease. Electric toothbrushes and water flossers can facilitate dental care. Large grips can be added to the handles of manual toothbrushes, hairbrushes and other personal care items to make them easier to grip and manipulate.
Getting Dressed with Parkinson’s Disease
Dressing someone with Parkinson’s disease may become a time- and labor-intensive task as their motor skills and strength wane. In addition, muscle stiffness and painful muscle cramps (known as dystonia) can make dressing difficult and unpleasant. Whenever possible, replace buttons or zippers with Velcro fasteners. Opt for loose-fitting clothing, which is easier and more comfortable to get on and off. An extra-long shoehorn can help with putting on shoes while seated. One of the most important things for a caregiver to remember when providing assistance with dressing is to go slow and set aside plenty of time.
Adapting to Parkinson’s and Mobility Issues
A very common symptom of Parkinson’s is “freezing.” This happens when a person is walking or moving and suddenly experiences extreme rigidity and an almost complete loss of movement as if their feet are glued to the floor. When this happens, prompting can help your loved one become “unstuck.” Ask them to pretend that they are stepping over an imaginary line or object on the floor or even encourage them to rock very slowly and gently from side to side to help them get moving again. If freezing is a common occurrence for your loved one, consider purchasing a specialty mobility device like a walker or rollator that is equipped with a laser pointer. When freezing occurs, they can simply press a button to project a laser line on the floor and use it as a visual cue to help them continue moving.
Massage therapy for Parkinson’s patients can alleviate stress and relieve spasms, tremors, rigidity and muscle cramps. Heating pads also soothe aching muscles, and mineral ice does wonders for stiff joints.
Exercise can be difficult at first but very beneficial for those living with PD. Encourage your loved one to do hand exercises like squeezing a rubber ball for short periods of time throughout the day to help reduce tremors and to keep hands and fingers strong and flexible. Even short daily walks and a mild fitness routine can keep muscles, tendons and joints strong for as long as possible.
Eating with Parkinson’s Disease
Specially designed eating utensils with padded or built-up handles help facilitate the eating process. Individuals with difficulty controlling the fine motor skills necessary for eating and drinking may also benefit from weighted utensils and cups. Knives with a curved blade can allow PD patients to cut their own food with a rocking motion instead of the traditional sawing motion that may be difficult to control. Serving meals in bowls or on plates with high lips or sides can make it much easier for patients to scoop food onto utensils and encourages self-feeding. Dishware with non-skid rubber bottoms can be helpful as well.
Depending on the severity of a senior’s condition, a caregiver may need to assist with hand feeding. This process should not be rushed. Generally, it may take 30 to 45 minutes or more to finish a meal. People with Parkinson’s may experience difficulties with eating, such as drooling, excessive chewing or difficulty swallowing (known as dysphagia). It is estimated that 80 percent of Parkinson’s patients develop swallowing problems at some point during the course of their disease. Signs of dysphagia include increased drooling and frequent coughing and choking during meals and while drinking. In some cases, it may be necessary to purée foods or to make sure they are finely chopped to facilitate eating and prevent aspiration of food particles and saliva into the lungs. A speech-language pathologist must conduct a swallowing study to diagnose dysphagia and prescribe any appropriate dietary changes. At this stage, a caregiver should be present during all meals.
Prescription medications may cause dry mouth, so it is very important to always encourage your loved one to sip on liquids during meals and throughout the day. This will help facilitate eating and swallowing and ensure they stay well hydrated.
Coping with Cognitive Changes and Parkinson’s
Cognitive decline and behavioral changes often occur in the middle and later stages of Parkinson’s disease. Caregivers must be particularly understanding and flexible when loved ones begin experiencing changes in memory and thinking. A PD patient may have trouble with planning, problem-solving, multitasking and spatial reasoning, which can make daily activities frustrating, impossible or even dangerous. It’s important to encourage independence but remain focused on ensuring their safety.
Changes in a loved one’s brain may also affect their ability to communicate. Approximately 89 percent of people diagnosed with Parkinson’s disease also have some type of progressive motor speech disorder. A PD patient’s voice may become softer or hoarser, they may have difficulty finding words, or their speech may become slurred. Working with a speech therapist can help an elder maintain their communication skills and confidence in social settings. Continue to encourage open communication, minimize distractions, and allow more time for responses as well as verbalized requests.
Improving Quality of Life with Parkinson’s Disease
The symptoms of Parkinson’s can have a significant impact on a senior’s physical, mental and social health, but family caregivers have the ability to make life much easier for loved ones who are living with this condition. By learning about PD and planning ahead, a caregiver may be able to anticipate problems or issues before they negatively affect a loved one.
Sources: Nonfatal Bathroom Injuries Among Persons Aged ≥15 Years --- United States, 2008 (https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6022a1.htm); Parkinson’s Foundation: Movement Symptoms (https://www.parkinson.org/Understanding-Parkinsons/Movement-Symptoms); Parkinson’s Disease – Diagnosis and Treatment (https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/diagnosis-treatment/drc-20376062); Parkinson's Disease Dementia (https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/parkinson-s-disease-dementia); Dysphagia in Parkinson's Disease. (https://www.ncbi.nlm.nih.gov/pubmed/26590572); Multifaceted Communication Problems in Everyday Conversations Involving People with Parkinson’s Disease (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664050/)