Clinical Interventions in Aging (Jul 2019)
Sex-related differences in homebound advanced Parkinson’s disease patients
Abstract
Lynda Nwabuobi,1 William Barbosa,2 Meghan Sweeney,3 Sarah Oyler,4 Talia Meisel,5 Alessandro Di Rocco,6 Joshua Chodosh,7,8 Jori E Fleisher91Department of Neurology, Movement Disorders Division, Columbia University Medical Center, New York, NY, USA; 2New York University School of Medicine, New York, NY, USA; 3Department of Palliative Care, Kaiser Permanente, Lafayette, CO, USA; 4Intermountain Neurosciences Institute, Intermountain Medical Center, Murray, UT, USA; 5State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, USA; 6Department of Neurology, Movement Disorders Division, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island, NY, USA; 7Division of Geriatric Medicine and Palliative Care, New York University Langone Health, New York, NY, USA; 8Veterans Affairs NY Harbor Healthcare System, NY, New York, USA; 9Section of Movement Disorders, Department of Neurological Sciences, Rush Medical College, Rush University, Chicago, IL, USABackground: Women with Parkinson’s disease (PD) are more likely to be older, have greater disease severity and comorbidities, and yet are less likely to receive care from a neurologist, as compared with men with PD. Within the PD population, homebound individuals are a particularly vulnerable group facing significant barriers to care, yet within this understudied population, sex-related differences have not been reported.Purpose: To identify and describe differences in homebound men and women with advanced PD and related disorders, participating in an interdisciplinary home visit program.Patients and methods: This was an exploratory analysis of homebound patients seen between February 2014 and July 2016 using data collected via in-person interviews and chart review.Results: We enrolled 85 patients, of whom 52% were women. PD was the most common diagnosis (79%), followed by dementia with Lewy bodies (5%), and other atypical parkinsonism (16%). Men were more likely to have a PD dementia diagnosis than women (17.1% vs 2.3%, p=0.03). Women were more likely to live alone (18.1% of women had no caregiver vs 2.4% of men, p=0.05).Conclusion: The role of the caregiver in facilitating safe aging-in-place is crucial. Among homebound individuals with advanced PD, women were far more likely to live alone. The absence of a spouse or care partner may be due in part to variable sex-based life expectancies. Our findings suggest that homebound women with advanced PD may face greater barriers to accessing support.Keywords: parkinsonism, gender disparities, caregiver, aging, health services, health disparities
