The Effect Of Health Education On The Ability To Perform Activities Of Daily Living in Patients With Parkinson's Disease

Parkinson's disease (PD) is a chronic, progressive, degenerative disease with a high disability rate, especially in the late stages, when patients become severely myoclonic, rigid, and bedridden. We provided health education to 68 patients with PD, which significantly improved their ability to perform activities of daily living, and the following is based on the full range of factual occurrences.

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Information and Methods

1.1 General data 

Sixty-eight patients with PD were seen in the Department of Neurology, China Medical College from January 2006 to January 2008. The criteria of the group: ① age ≤65 years old; ② education level above elementary school; ③ informed consent; ④ hospitalization time more than 10 days; ⑤ no communication barriers. Among them, 41 cases (62.0%) were male and 27 cases (38.0%) were female; the average age was 62.06±3.96 years; education level: 24 cases (35.29%) in junior high school, 30 cases (44.12%) in junior high school or high school, and 14 cases (20.59%) in college and above. The duration of hospitalization was (13.87±4.31) days. 

1.2 Methods 

1.2.1 Assessment of patients' activities of daily living (ADLs) The patients' ADLs were assessed using the Bar-the1 ADLs scale. Systematic health education was provided for 10 days to address the patients' problems, followed by regular guidance, telephone consultation, and regular lectures. The initial assessment was repeated 6 months later to compare the changes in the patient's ADLs.

1.2.2 Content of health education

1.2.2.1 Mental health guidance This disease is mostly found in middle-aged and elderly people, with a long course and incurable, slow, and clumsy movements in the early stage, and gradually developing self-care ability as the disease develops. After admission, we explain the general knowledge of the disease to the patients, so that they can have an overall understanding of their disease, face it squarely, actively cooperate with treatment and care, and build up confidence in overcoming the disease. Talk with the patient, understand the patient's psychological reaction, and adopt effective comfort methods according to the patient's psychological state. Guide patients to establish good relationships with people around them and actively participate in social activities. The patient is instructed to use the Depression Self-Assessment Scale to detect depressive symptoms early and to take antidepressants according to medical advice as appropriate.

1.2.2.2 Patients often suffer from intractable constipation, which is caused by insufficient exercise and impaired peristalsis of the digestive tract. If the patient's condition permits, he/she should drink a glass of honey water in the morning and defecate after appropriate activities, so as to develop the habit of regular defecation. If the patient has a urinary frequency, urgency, or urinary retention, ask him/her to drink more water, keep the perineum clean, and retain catheterization if necessary. Teach them to inhale and then hold their breath during defecation and urination, and to use the method of increasing abdominal pressure to defecate and urinate. 

1.2.2.3 Dietary guidance As the disease progresses, patients develop head and facial tremors, and oropharyngeal and palatal muscle movement disorders, resulting in inadequate nutritional intake. 70% of patients have weight loss. The amount of protein intake should be limited to less than 0.8 g per kg of body weight per day, with a total of about 40-50 g per day. The patient should consume a high sugar and fat diet for breakfast and lunch, and a high protein diet for dinner, because the amino acids decomposed when the patient consumes a large amount of protein containing neutral amino acids will compete with levodopa for the human brain, which will reduce the amount of levodopa in the human brain and weaken the efficacy of the drug. The food should be soft, easily digestible porridge, vegetable puree, meat puree, jam, etc., striving for color and flavor, 4-5 meals per day, the total daily amount of 2,000-2,5OO g. Rinse the mouth after each meal to remove food residues. For those who have serious difficulty in eating, nasal feedings and homogenized meals should be made with a blender.

1.2.2.4 Medication instruction According to the patient's medication status, a health card is made to explain in detail the effects, dosage, administration methods, adverse reactions, precautions, and simple emergency treatment of various medications, emphasizing that medications must be taken as prescribed by the doctor and should never be stopped or reduced at will. In addition, we recommend tips for patients to take their medications on time, such as preparing a list of medications for them to take at the same time every day, using an alarm clock or timer to remind themselves, telling them to take their medications with them when they go out, and refilling their medications as soon as possible when they have two weeks' supply left.

1.2.2.5 Functional rehabilitation instruction According to the condition, a training plan is developed, and patients are given relaxation training, joint range of motion training, mobility training, balance activities, daily function training, respiratory function training, gait training, and maintenance therapy according to the exercise therapy for PD. Exercise must be individualized, 3-5 times a day, 20-3 minutes each time. Exercise must be early, comprehensive, appropriate, consistent, and performed within the prescribed time every day without interruption, avoiding strain and trauma. At the same time, it is important to eliminate negative factors that affect rehabilitation training, such as pain, fear of falling, and dependence on others for assistance, and to enhance the patient's understanding of rehabilitation training. 

1.2.2.6 Safety instructions Patients should create a safe environment at home, use chairs with armrests, lower the height of the bed, use non-slip floor tiles, wrap the sharp corners of cabinets with towels and adhesive paper, place objects in a fixed and orderly manner in the living room, have sufficient light, and avoid direct light; set up a high stool when squatting in the toilet or having difficulty in standing up; set up safety handrails at the bathtub; and wear non-slip shoes with rubber soles. Family members should take the initiative to care for and be considerate of PD patients to create a warm and harmonious family atmosphere.

1.2.3 Health education methods

lecture, video, and health education cards. A health education team was established, consisting of 4 nurses with uniform training, and the patients were instructed for 1 h in the morning and 1 h in the afternoon every day, and the instruction was conducted in a one-to-one manner. 

1.3 Statistical treatment 

Measurement data were expressed as ±, and the group comparison was done by the test, and the difference was considered statistically significant at P<0.O5.

Results

Each PD patient was able to complete the health education content as requested by the education team nurse. The comparison of the ability of daily living activities of PD patients before and after health education is shown in Table 1.

Table 1 Comparison of patients' ability to perform daily living before and after health education ( ±s, points)

The patient's ability to do daily living was significantly higher after health education than before health education (P

Disclosure

1. The need for health education for PD patients.

PD is a progressive disease with irreversible impairment of life and social skills. Without active and effective exercise, patients' survival time is shortened and their quality of life decreases. Some patients have a tendency to depression, pessimism, lack of interest in things, anxiety and agitation, poor memory, and dementia in about 14 to 80% of patients. 70% of patients have weight loss. In order to improve the ability to daily living activities and quality of life of PD patients, and to prevent the secondary dysfunction of PD, it is necessary to provide relevant health education to patients along with drug treatment, so as to improve the ability of daily living activities, improve the quality of life and reduce the burden of families.

2. Problems encountered in the implementation of health education.

In the process of health education, we found that some patients were fearful of long-term functional rehabilitation and lacked confidence, and some patients had low literacy levels, were older, and had poor acceptance skills.

3. Effectiveness of health education for PD patients

Through the implementation of planned and systematic health education, patients had a more comprehensive understanding of PD and were able to actively accept behaviors conducive to recovery. In the process of health education, patients were highly motivated to learn, with l00% of patients receiving 10 days of systematic health education, 92.5% receiving telephone consultation guidance, and 83% attending health education lectures. The patient's ability to perform activities of daily living was significantly improved, indicating that health education is effective.