Hospice Care for Advanced Parkinson's Disease

Motor Symptom Management

The American Academy of Neurology recommends continuing levodopa/carbidopa at the current effective dose, as it remains the most effective treatment for motor symptoms even in advanced disease 1, 2
The International Parkinson and Movement Disorder Society suggests taking levodopa 30 minutes before meals to optimize absorption 1, 2
A protein redistribution diet, with most protein at the end of the day, may be considered for patients with motor fluctuations 1, 2

The European Society for Clinical Nutrition and Metabolism recommends optimizing antiparkinsonian medications to improve motor components of swallowing 4
Dietary modifications, such as thickened liquids, soft foods, and small frequent meals, may be implemented to manage dysphagia 4
The American Gastroenterological Association suggests considering FEES (fiberoptic endoscopic evaluation of swallowing) for objective assessment if prognosis allows 4

The European Society of Cardiology recommends sitting upright, hand-held fans, relaxation techniques, and breathing exercises for dyspnea management 5
Low-dose opioids, such as morphine, may be considered for refractory dyspnea 5
Benzodiazepines may be used for anxiety-associated dyspnea, but with caution due to sedation, fall risk, and cognitive impairment 5

The American Psychiatric Association recommends melatonin as the preferred treatment for REM sleep behavior disorder, especially in older patients 2
Benzodiazepines may be used for anxiety, but with caution due to sedation, fall risk, and cognitive impairment 2

The European Society of Medical Oncology recommends anticonvulsants, antidepressants, or opioids for neuropathic pain management 5
Opioid options, such as tramadol, oxycodone, hydromorphone, and fentanyl, may be considered for pain management 5

The European Society of Cardiology recommends support stockings and leg elevation for edema management 5
Diuretic therapy, such as IV or subcutaneous administration, may be considered in the home or hospice setting 5

The American Heart Association recommends documenting resuscitation preferences (DNR/DNI status) and addressing preferences for artificial hydration and nutrition 5

The American Academy of Neurology recommends avoiding abrupt discontinuation of levodopa, as it remains beneficial for symptom control even in terminal stages 1, 2
The International Parkinson and Movement Disorder Society suggests avoiding clonazepam for REM sleep behavior disorder due to morning sedation, gait imbalance, falls, depression, and cognitive impairment 2
The European Society for Clinical Nutrition and Metabolism recommends avoiding strict protein restriction, as it can cause malnutrition without proven benefit 1, 2