A Systematic Review of the Parkinson's Foundation Hospital Care Recommendations

Background: People with Parkinson's disease (PwP) face increased risks of complications and longer hospital stays compared to the general population. Four major factors contribute to increased morbidity and mortality during hospitalization: medication timing errors, administration of harmful medications, restricted mobility, and dysphagia. Objectives: To systematically review the literature on medication timing, contraindicated medications, mobility, and dysphagia in hospitalized PwP, and to evaluate the strength of evidence supporting the Parkinson's Foundation's consensus recommendations for inpatient care. Methods: A systematic review was conducted by searching MEDLINE and EMBASE databases up to February 1, 2024. Original research articles involving hospitalized PwP were included. The level of evidence for each Parkinson's Foundation recommendations was assessed. Results: The review included 33 studies. Multiple studies showed that medication errors were associated with longer hospital stays, motor deterioration, and increased mortality in PwP. Interventions such as electronic medical record alerts, staff education, and specialized PD units reduced medication errors. Limited evidence was found on the impact of immobility and dysphagia during hospitalization. Conclusions: The evidence base supporting the Parkinson's Foundation's hospital care recommendations varies in strength. Recommendations regarding medication timing and avoiding harmful medications are supported by multiple observational studies, while those for mobility and dysphagia are primarily based on expert opinion. Implementing these recommendations through multidisciplinary interventions may improve hospital care quality for PD. However, more high-quality research, including randomized controlled trials, is needed to evaluate intervention impacts and address identified knowledge gaps.