Patients with Parkinson's disease suffer from hand tremor, rigidity of joints, slow movement, and walking instability, which affect their daily lives, and can even lead to depression. Carers should help patients maximize their self-care abilities by giving appropriate assistance rather than do everything for them. Otherwise, their functional mobility and self-care abilities would deteriorate faster due to lack of practice. Carers can teach the patients some adaptive skills, select suitable assistive devices and provide guidance and encouragement patiently to assist patients in maintaining and enhancing their self-care ability.

Since patients have different levels of impairment in terms of functional mobility and self-care, carers can apply the following caring skills according to individual needs.

Tips for Daily Living

Feeding

For easier feeding - Patients should be encouraged to eat independently as much as possible, using a spoon with weighted handle to reduce tremor, a non-slip mat to keep utensils in place (diagram 1), a scooper bowl to prevent spilling when food is being scooped out (diagram 2), and a specially weighted cup with bilateral handles to help reduce tremor (diagram 3). For those who eat slowly, try using a thermos container to keep the food warm . To avoid choking - Sit up straight with chin tilted downward during mealtime. Avoid lying down or head tilted backward while eating. Cut food into smaller pieces or prepare pureed meals if necessary. Food which is too dry (e.g. biscuits, toasts), too hard (e.g. nuts), too slippery (e.g. konjac jelly, whole piece of grape) or too sticky (e.g. glutinous rice dumplings, glutinous rice cake, etc.) may cause choking . These foods should be cut into small pieces, then chewed carefully and swallowed slowly without hurry. To prevent constipation - A high fiber diet (like vegetables, fruits, oatmeal) and adequate fluid intake is encouraged.

Diagram 1 Diagram 2 Diagram 3

Grooming and Dressing

For easier personal grooming - Choose toothbrushes with thicker handles for a better grip; electric toothbrushes can be used as well. An electric razor is easier to control and reduces the chance of injury. For easier dressing - Choose clothing that is easy to wear, such as clothes that have a bigger collar, loose sleeves, vest design or front opening design. Suitable modifications include large buttons or Velcro for clothes, using elastic band instead of zip fastening for trousers, and elastic band or Velcro fastening for shoes. Use a buttoning aid to assist with buttoning up (diagram 4). To prevent falls - Sit down when putting on a pair of trousers, and avoid trousers which are too long or too loose. Shoes should be well-fitted, preferably with non-slip soles. Replace shoes when they look worn out. Shoes which fasten without shoelaces or use Velcro are most suitable.

Diagram 4

Transfer and Walking

For easier transfer - Chairs and beds should be of suitable height; when sitting on the chair or bedside, feet should be flat on the ground. Chairs with armrests offer support when rising from the chair (diagram 5). To prevent falls - Always stand with feet apart for balancing to avoid falling backward. If necessary, suitable walking aids should be used.

Diagram 5

Toileting and Bathing

For easier toileting and bathing - If the toilet bowl is too low, a raised toilet seat can allow the patient to stand up more easily after toileting. Install secure handrails at suitable places to facilitate the transfer (diagram 6). To prevent falls - Place non-slip mat inside and outside the bath tub or shower cubicle to prevent slipping. Climbing in and out of the bath tub could be dangerous; a shower cubicle is safer. Shower curtains are preferred instead of a sliding glass door. A stable shower chair or a bathboard can also be used (diagram 7) for sitting in the shower. A hand-held shower hose can aid showering of the back without needing to turn around. (For further information, please consult healthcare professionals.)

Diagram 6 Diagram 7

Home environment

1. To prevent falls - Keep the passageway clear of unnecessary items to allow enough space for turning and use of walking aid. Loose wires should be fixed against the wall. Ensure the floor is flat and dry to prevent falls. Ensure adequate lighting. Corridor and bedside lights facilitate going to the toilet at night time. Place non-slip mats at the kitchen and bathroom entrance. Label door thresholds with non-slip sharp coloured strips to alert the patient.
2. To prevent accident - Install and carry an Emergency Alarm System if patient is living alone.

Communication skills

Use communication skills - Reduce background noise. Sit face-to-face with patient. Keep good eye contact and listen attentively. Ask simple questions to guide conversation. Encourage patients to speak slowly and to use simple words or phrases and body gestures to facilitate communication e.g. nodding to represent "yes". If patients experience much difficulty with speaking, writing or drawing pictures on cards can help.

Mental Health

Prevent of Depression - Patients are more prone to depression. Therefore reassurance and support from family members and caregivers are very important. Watch for any change in emotion or behavior for early detection of depression.

Prevention of complications (For bed-ridden patients)

1. To prevent bedsores - Keep the skin clean and dry. Observe the skin condition of pressure areas for any signs of bedsores such as redness and ulcers. Change patient's position at least every 2 hours to avoid prolonged pressure on bony prominences. Avoid placing heavy objects on the limbs. Encourage the patient to perform appropriate exercises.
2. To prevent chest infection - Patients usually have difficulty in coughing and spitting. Encourage patients to increase water intake, daily activities, sit up during meal times and improve their immunity. Perform deep breathing and coughing exercises can help to reduce the chance of developing a chest infection.