title: Deterioration of Parkinson's disease during hospitalization: survey of 684 patients.
abstract: BACKGROUND
  A substantial fraction of Parkinson's disease patients deteriorate during hospitalisation, but the precise proportion and the reasons why have not been studied systematically and the focus has been on surgical wards and on Accident & Emergency departments. We assessed the prevalence and risk factors of deterioration of Parkinson's disease symptoms during hospitalization, including all wards.
  
  
  METHODS
  We invited Parkinson's disease patients from three neurology departments in The Netherlands to answer a standardised questionnaire on general, disease and hospital related issues. Patients who had been hospitalized in the previous year were included and analysed. Possible risk factors for Parkinson's disease deterioration were identified. Proportions were analysed using the Chi-Square test and a logistic regression analysis was performed.
  
  
  RESULTS
  Eighteen percent of 684 Parkinson's disease patients had been hospitalized at least once in the last year. Twenty-one percent experienced deterioration of motor symptoms, 33% did have one or more complications and 26% had received incorrect anti-Parkinson's medication. There were no statistically significant differences for these variables between admissions on neurologic or non-neurologic wards and between having surgery or not. Incorrect medication during hospitalization was significantly associated with higher risk (OR 5.8, CI 2.5-13.7) of deterioration, as were having infections (OR 6.7 CI 1.8-24.7). A higher levodopa equivalent dose per day was a significant risk factor for deterioration. When adjusting for different variables, wrong medication distribution was the most important risk factor for deterioration.
  
  
  CONCLUSIONS
  Incorrect medication and infections are the important risk factors for deterioration of Parkinson's disease patients both for admissions with and without surgery and both for admissions on neurologic and non-neurologic wards. Measures should be taken to improve care and incorporated in guidelines.
authors.affiliation: Section of Movement Disorders, Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands. o.gerlach@mumc.nl
authors.forename: Oliver H H
authors.initials: OH
authors.lastname: Gerlach
authors.forename: Martijn P G
authors.initials: MP
authors.lastname: Broen
authors.forename: Peter H M F
authors.initials: PH
authors.lastname: van Domburg
authors.forename: Ad J
authors.initials: AJ
authors.lastname: Vermeij
authors.forename: Wim E J
authors.initials: WE
authors.lastname: Weber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology*; D012307:Risk Factors
chemical_list: D000978:Antiparkinson Agents