Sex-related differences in homebound advanced Parkinson’s disease patients

Abstract

Background

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

Acknowledgments

This work was supported by the Edmond J. Safra Philanthropic Foundation, the National Parkinson Foundation, the Parkinson Alliance, the Doris Duke Fund to Retain Clinical Scientists, the Feldstein Medical Foundation; and the National Institutes of Health (2L30NS084235-02, 2L30NS084235-03, 2L30NS084235-04, and 1K23NS097615.). None of the funding sources were involved in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.

Author Contributions

All authors contributed towards data analysis, drafting and critically revising the paper, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work. Lynda Nwabuobi contributed to concept, analysis and interpretation of data, literature search, drafting, and revision of the manuscript. William Barbosa, Meghan Sweeney, Sarah Oyler, alia Meisel contributed to data acquisition, revision, and critique of the manuscript. Alessandro Di Rocco and Joshua Chodosh contributed to conception and design of study, revision, and critique of the manuscript. Jori E Fleisher contributed to conception and design of study, project organization, data acquisition, statistical analysis and interpretation of data, revision, and critique of the manuscript.

Disclosure

Dr Di Rocco has received grant support from the Parkinson Alliance, Parkinson Foundation, and Edmond J. Safra Philanthropic Foundation.

Dr Chodosh has received research support from the National Institutes of Health, New York State Department of Health, and Independence at Home, Long Beach, CA, USA; has received honoraria from Gerontological Society of America; serves on the advisory board of Aging in New York Fund; and has no personal conflicts to disclose.

Dr Fleisher has received research support from the Feldstein Medical Foundation, Doris Duke Charitable Foundation Fund to Retain Clinical Scientists, National Institutes of Health/National Institute of Neurological Disorders and Stroke, CurePSP, and Biogen. She has received honoraria from Parkinson’s Foundation and royalties from UpToDate.

The other authors report no conflicts of interest in this work.