title: Management of the hospitalized patient with Parkinson's disease: current state of the field and need for guidelines.
abstract: OBJECTIVE
  To review the literature and to identify practice gaps in the management of the hospitalized Parkinson's disease (PD) patient.
  
  
  BACKGROUND
  Patients with PD are admitted to hospitals at higher rates, and frequently have longer hospital stays than the general population. Little is known about outpatient interventions that might reduce the need for hospitalization and also reduce hospital-related complications.
  
  
  METHODS
  A literature review was performed on PubMed about hospitalization and PD between 1970 and 2010. In addition, in press peer-reviewed papers or published abstracts known to the authors were included. Information was reviewed by a National Parkinson Foundation workgroup and a narrative review article was generated.
  
  
  RESULTS
  Motor disturbances in PD are believed to be a causal factor in the higher rates of admissions and complications. However, other conditions are commonly recorded as the primary reason for hospitalization including motor complications, reduced mobility, lack of compliance, inappropriate use of neuroleptics, falls, fractures, pneumonia, and other important medical problems. There are many relevant issues related to hospitalization in PD. Medications, dosages and specific dosage schedules are critical. Staff training regarding medications and medication management may help to avoid complications, particularly those related to reduced mobility, and aspiration pneumonia. Treatment of infections and a return to early mobility is also critical to management.
  
  
  CONCLUSIONS
  Educational programs, recommendations, and guidelines are needed to better train interdisciplinary teams in the management of the PD patient. These initiatives have the potential for both cost savings and improved outcomes from a preventative and a hospital management standpoint.
authors.affiliation: National Parkinson Foundation Center of Excellence, University of California San Francisco, Neurology Department, CA, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Aminoff
authors.forename: Chad W
authors.initials: CW
authors.lastname: Christine
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Friedman
authors.forename: Kelvin L
authors.initials: KL
authors.lastname: Chou
authors.forename: Kelly E
authors.initials: KE
authors.lastname: Lyons
authors.forename: Rajesh
authors.initials: R
authors.lastname: Pahwa
authors.forename: Bastian R
authors.initials: BR
authors.lastname: Bloem
authors.forename: Sotirios A
authors.initials: SA
authors.lastname: Parashos
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Price
authors.forename: Irene A
authors.initials: IA
authors.lastname: Malaty
authors.forename: Robert
authors.initials: R
authors.lastname: Iansek
authors.forename: Ivan
authors.initials: I
authors.lastname: Bodis-Wollner
authors.forename: Oksana
authors.initials: O
authors.lastname: Suchowersky
authors.forename: Wolfgang H
authors.initials: WH
authors.lastname: Oertel
authors.forename: Jorge
authors.initials: J
authors.lastname: Zamudio
authors.forename: Joyce
authors.initials: J
authors.lastname: Oberdorf
authors.forename: Peter
authors.initials: P
authors.lastname: Schmidt
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
mesh_terms: D006301:Health Services Needs and Demand; D006760:Hospitalization; D006801:Humans; D010300:Parkinson Disease / Q000150:complications / Q000628:therapy*; D039781:PubMed / Q000706:statistics & numerical data; D016896:Treatment Outcome