Objective: To describe sex differences in homebound patients with advanced Parkinson’s disease and related disorders in an interdisciplinary home visit program (HVP)

Background: It has been shown that sex is a determinant in the quality of care and disease progression of patients with Parkinson’s disease. Women with PD are more likely to be older and have greater disease severity and more comorbidities than men despite similar duration of disease. Women are also less likely to be treated by a neurologist and less likely to receive DBS. Within the PD population, homebound individuals are a particularly vulnerable population facing significant barriers to care. In the context of an HVP, we sought to compare baseline characteristics among homebound men and women with advanced PD and related disorders.

Methods: Retrospective analysis of patients enrolled in the Edmond J. Safra Interdisciplinary Home Visit Program for Advanced PD seen between February 2014 and July 2016. Data collected via in-person interviews and chart review.

Results: We enrolled 85 patients, of whom 52% were women, with a median age of 79.6 years at the initial home visit. PD was the most common diagnosis (79%), followed by DLB and PSP (5% each), MSA (2%), and atypical parkinsonism (9%). Mean total UPDRS at Visit 1 was significantly higher in men than women (85.6 vs 71.2, p <0.01). Men were more likely to bear a PD dementia diagnosis than women (15.5% vs. 0.7%). Women were less likely than men to have any caregiver present (20.5% of women had no caregiver vs. 4.9% of men, Fisher’s exact p = 0.05). Women were more likely to be widowed (45% vs 12%) or single (18% vs. 7%); men were more likely to be married (68% vs. 30%) (p <0.01).

Conclusions: Among homebound advanced PD patients, there are sex differences at baseline, including women having a far higher likelihood of living alone. The role of the caregiver in facilitating safe aging-in-place is crucial. While the absence of a spouse or partner caregiver may be explained by variable life expectancies between the sexes, these findings suggest that homebound women with advanced PD may face even greater barriers to accessing care than their male counterparts and may be at higher risk of loss to follow-up without concerted efforts at continuity of care.

References: Dahodwala N, Pei Q, Schmidt P. Sex Differences in the Clinical Progression of Parkinson’s Disease. J Obstet Gynecol Neonatal Nurs 2016; 45(5):749-56

Willis AW, Schootman M, Evanoff BA, Perlmutter JS, Racette BA. Neurologist care in Parkinson disease: a utilization, outcomes, and survival study. Neurology 2011; 77(9):851-7

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MDS Abstracts - https://www.mdsabstracts.org/abstract/sex-differences-in-homebound-advanced-parkinsons-disease-patients/