title: Neurologic disease at the end of life: caregiver descriptions of Parkinson disease and amyotrophic lateral sclerosis.
abstract: OBJECTIVE
  Amyotrophic lateral sclerosis (ALS) is well recognized as a terminal illness with an established need for palliative care. Parkinson's disease is a substantially more common cause of death, yet little has been written about the palliative needs of these patients at the end of life. To highlight the palliative care needs and experiences of patients with Parkinson's disease and related disorders (PDRD), we compared them to patients with ALS.
  
  
  METHODS
  Family caregivers of decedent PDRD and ALS patients in Oregon and Washington were surveyed about their loved one's symptoms, treatment preferences, health care usage, and psychosocial experiences during the last month of life.
  
  
  RESULTS
  Fifty-two PDRD and 50 ALS caregivers completed the survey. Overall suffering (1 = none to 6 = severe) was rated a median of 4 for both groups. Pain was moderately severe or worse in 42% of PDRD patients and 52% of ALS patients; of these, 27% of PDRD and 19% of ALS patients received no pain medication in the last month. PDRD featured more severe effects of confusion than ALS, although less dyspnea and difficulty eating. PDRD patients had significantly shorter hospice enrollments than ALS patients (p < 0.01).
  
  
  CONCLUSIONS
  In the views of caregivers, suffering associated with ALS is no more severe than suffering associated with PDRD, and both groups appear to have unmet palliative care needs in the last months of life. Studies to define hospice readiness and special needs in hospice might improve end-of-life care for PDRD patients.
authors.affiliation: Department of Research/Mental Health, Portland VA Medical Center, Portland, Oregon 97207, USA. elizabeth.goy@va.gov
authors.forename: Elizabeth Ruth
authors.initials: ER
authors.lastname: Goy
authors.forename: Julie
authors.initials: J
authors.lastname: Carter
authors.forename: Linda
authors.initials: L
authors.lastname: Ganzini
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000401:mortality / Q000523:psychology; D017028:Caregivers / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009922:Oregon; D010147:Pain Measurement; D010166:Palliative Care / Q000523:psychology*; D010300:Parkinson Disease / Q000401:mortality / Q000523:psychology; D011594:Psychometrics; D011795:Surveys and Questionnaires; D014861:Washington