Multimorbidity and Frailty: Tackling Complexity in Parkinson's Disease

Abstract

Parkinson's disease (PD) is a condition that predominantly affects older people. It is imperative that clinical management considers the other significant illnesses that people with PD accumulate as they age in conjunction with their resilience to cope with physiological change. Multimorbidity and frailty act synergistically to heighten the risk of adverse outcomes for older people with PD. These states are associated with increased likelihood of hospitalization, polypharmacy, adverse drug effects including the anticholinergic burden of medications, drug-disease and drug-drug interactions. Management should be integrated, holistic and individualised to meticulously balance the risks of interventions considering the vulnerability of the individual to recover from disturbance to their environmental, physical and cognitive equilibrium.

Keywords: Aging; Parkinson’s disease; comorbidity; frailty; integrated care; multimorbidity; polypharmacy.

Fig.1

The impact of multimorbidity and frailty in Parkinson’s disease. Many individuals with Parkinson’s disease will experience the disease in the context of multimorbidity and/or be living with frailty. In these circumstances, relatively small physiological insults ‘tip the balance’ precipitating decompensation of a fragile equilibrium. Prescribing cascades, whereby ever-increasing number of drugs are added to ameliorate adverse effects of other drugs, can add to polypharmacy and precipitate adverse events such as falls and fractures. This frequently necessitates hospitalization resulting in experience of delirium, deconditioning and worsening disability. Already diminished physiological reserve and resilience are further eroded, fuelling the vicious cycle and negatively impacting quality of life. © Tenison/Henderson.