Being hospitalized is never easy. For people with Parkinson’s disease (PD), it can be even more challenging. Parkinson’s symptoms may worsen, and new issues can arise—such as confusion, thinking problems, trouble swallowing, or muscle weakness. These changes can be triggered by the stress of hospitalization, infections, lack of sleep, surgery, or new medications.
A recent study analyzing over 35,000 hospital stays involving people with PD found a concerning rise in two common and preventable complications: delirium and aspiration pneumonia. The good news is that with proper planning and communication with the medical team, these risks can be significantly reduced.
Here are four key recommendations for patients and caregivers that can make a big difference during a hospital stay:
1. Avoid medications that are unsafe for people with Parkinson’s
Many common hospital medications—such as those for nausea, pain, or digestion—can negatively impact people with Parkinson’s. These drugs can worsen motor symptoms, cause new cognitive issues, or trigger delirium, which is a sudden and reversible disturbance in attention and thinking.
Additionally, many antipsychotics used to treat delirium or agitation are unsafe for people with PD because they block dopamine—a brain chemical that is already reduced in Parkinson’s patients.
Only three antipsychotics are considered safe in this context:
Pimavanserin (Nuplazid)
Quetiapina (Seroquel)
Clozapina (Clozaril)
All other antipsychotics should be avoided unless absolutely necessary and carefully monitored.
Key recommendation: Before any procedure or new treatment, share with the medical team a list of medications that should be avoided in Parkinson’s. This information can be found in the Parkinson’s Care Summary.
2. Stick to a strict Parkinson’s medication schedule
One of the most critical needs during a hospital stay is receiving Parkinson’s medications on time and at the correct doses. Missing or delaying these medications can lead to stiffness, slowness, falls, or swallowing problems—which in turn can cause serious complications like aspiration pneumonia.
In many hospitals, medication schedules aren’t tailored to the individual needs of people with PD. That’s why it’s essential for patients and caregivers to take an active role in helping the care team understand how important timing is.
Helpful tips:
Use a Medication Form to list each drug, the exact dose, and the specific time it must be taken. Include over-the-counter meds and supplements, too.
If swallowing pills is difficult, talk to a nurse or speech therapist about safe alternatives, like crushing the pill or using liquid forms or food (such as applesauce)—only if approved.
3. Report any swallowing issues and ask to see a speech-language therapist
Dysphagia—difficulty swallowing—is a common symptom of PD and can become worse during a hospital stay. This increases the risk of aspiration, where food or liquids go down the wrong way into the lungs, potentially causing a serious infection known as aspiration pneumonia.
If you notice coughing while eating, a hoarse voice after drinking liquids, or a feeling that food is “stuck,” it’s important to alert the care team immediately.
What to do:
Ask for a speech-language therapist to assess your swallowing ability.
In some cases, oral feeding may need to be paused. If that happens, make sure to discuss alternative ways to take Parkinson’s medications.
After discharge, continue follow-up with a speech therapist to maintain or improve swallowing and communication.
4. Reduce the risk of aspiration pneumonia with a two-part strategy
Aspiration pneumonia is one of the leading causes of death among people with Parkinson’s. According to the National Institutes of Health (NIH), it accounts for up to 70% of PD-related deaths.
Preventing this complication requires a two-pronged approach:
- Prevent aspiration:
- Eat only when your medications are working well, to maximize muscle control.
- Sit upright while eating or drinking, and avoid lying down right after.
- Take small bites, chew thoroughly, and eat slowly.
- Reduce oral bacteria:
- Brush your teeth, gums, and tongue, and rinse your mouth before and after meals.
- Practice good oral hygiene—even if you use dentures.
Good oral care not only prevents infections but also lowers the amount of harmful bacteria that could reach your lungs in the event of accidental aspiration.
