4.3.3 Communication, speech and language difficulties

At end stage of Parkinson’s the individual may suffer a combination of hypophonia and dysarthria, which causes communication problems and difficulties with being understood. It is important to assist the person with Parkinson’s to have an effective alternative method for communication, to lessen their frustration and allow expression of their fears or anxieties.

DYSPHAGIA

Dysphagia may be associated with an increasing risk of silent aspiration at this stage of the condition, so the speech and language therapist will educate the person with Parkinson’s and family/carers in how to manage this (Kaif et al, 2012).

SIALORRHEA

It is recommended that non pharmacological intervention by the SALT is priority, but if that is not successful then glycopyrronium bromide is recommended as first line in pharmacological intervention.

Atropine eye drops can be used sublingually to ease sialorrhea with fewer side effects but only if there is a minimal risk of adverse cognitive effect and this will require regular assessment and monitoring. Oral hygiene is also an important factor in lessening distress and maintaining comfort.

4.3.2 Other types of pain

4.3.4 Artificial nutrition and hydration