{"id":53702,"date":"2023-05-10T16:56:15","date_gmt":"2023-05-10T15:56:15","guid":{"rendered":"https:\/\/touchneurology.com\/?p=53702"},"modified":"2023-06-02T15:33:59","modified_gmt":"2023-06-02T14:33:59","slug":"wellness-in-parkinsons-disease-a-framework-for-management-using-a-holistic-culturally-sensitive-approach","status":"publish","type":"post","link":"https:\/\/touchneurology.com\/parkinsons-disease\/journal-articles\/wellness-in-parkinsons-disease-a-framework-for-management-using-a-holistic-culturally-sensitive-approach\/","title":{"rendered":"Wellness in Parkinson\u2019s Disease: A Framework for Management Using a Holistic Culturally Sensitive Approach"},"content":{"rendered":"

In modern medicine,\u00a0<\/span>t<\/span>he concept of\u00a0<\/span>wellness<\/span>\u00a0is accompanied by many misconceptions.\u00a0<\/span>Adopting wellness as a treatment\u00a0<\/span>approach<\/span>\u00a0has been well defined and\u00a0<\/span>implemented in cardiovascular disease, diabetes and some types of cancer management<\/span>\u00a0but has not yet been widely applied to neurologic diseases.1\u20135<\/sup><\/span>\u00a0The commercialization of the\u00a0<\/span>wellness industry<\/span>\u00a0has led to the misconception of wellness as expensive and only accessible to a niche population who can afford gym memberships, massages, personal chefs and spa retreats.6<\/sup><\/span>\u00a0Hence, it is important to\u00a0define<\/span>\u00a0wellness\u00a0clearly<\/span>.\u00a0W<\/span>ellness includes both preventative and holistic features and can best be defined as\u00a0\u201c<\/span>the active pursuit of activities, choices and lifestyles that lead to a state of holistic health<\/span>\u201d<\/span><\/span>.7<\/sup><\/span>\u00a0Wellness is defined by the\u00a0World Health Organization<\/span>\u00a0(WHO<\/span>) as\u00a0\u201c<\/span>the optimal state of health for individual and groups\u201d<\/span>.8<\/sup><\/span>\u00a0It\u00a0<\/span>represents a strengths-based approach\u00a0to health<\/span>,<\/span>\u00a0which focuses<\/span>\u00a0on\u00a0a person’s\u00a0<\/span>positive attributes,<\/span>\u00a0a\u00a0<\/span>contrast to the traditional medical paradigm,<\/span>\u00a0which focuses on symptom mitigation.7<\/sup><\/span><\/p>\n

The WHO defined health as\u00a0\u201c<\/span>a state of complete physical, mental, and social\u00a0well-being<\/span>\u00a0and not merely the absence of disease or infirmity\u201d<\/span>.9<\/sup><\/span>\u00a0Wellness includes being engaged in attitudes that enhance\u00a0the\u00a0<\/span>quality of life and maximize personal potential; hence, the wellness model fits well with this broader WHO definition of health. The International Classification of Functioning, Disability, and Health<\/span>\u00a0was established to provide a comprehensive system for conceptualizing health in a holistic manner by considering the interplay between\u00a0the\u00a0<\/span>psychological, biological and social components of<\/span>\u00a0one\u2019s ability to function optimally.10<\/sup><\/span>\u00a0The\u00a0International Classification of Functioning, Disability and Health\u00a0<\/span>model encourages clinicians to both inquire about and consider the viewpoint of the individual patient regarding their health and wellness. Specific models of holistic health have been recently popularized,<\/span>\u00a0including the Veteran\u2019s Affairs Whole Health model.11<\/sup><\/span>\u00a0This model of wellness is a multidimensional patient-driven approach to health encompassing lifestyle, environment, social support<\/span>\u00a0and<\/span>\u00a0spiritual, mental, and physical wellbeing. For\u00a0people with\u00a0<\/span>Parkinson\u2019s disease\u00a0(PWP)<\/span><\/span><\/span><\/span>,\u00a0<\/span>the key components of wellness are a healthy diet, exercise, sleep, mind\u2013<\/span>body approaches and social connection<\/span>.12\u201315<\/sup><\/span>\u00a0Figure 1<\/span>\u00a0illustrates these<\/span>\u00a0key components of wellness,<\/span>\u00a0including<\/span>\u00a0the many referrals and collaborations that can enhance care for PWP.16<\/sup><\/span>\u00a0This\u00a0figure is<\/span>\u00a0an updated version of\u00a0the\u00a0<\/span>\u201c<\/span><\/span>The patient is the sun<\/span>\u201d<\/span>\u00a0figure by Bloem\u00a0et al<\/span>.17<\/sup><\/span>\u00a0We propose\u00a0\u201c<\/span>the active pursuit of more holistic health through individual lifestyle choices and not just the absence of disease\u201d<\/span>\u00a0framework as a revised approach to health provision for PWP.7<\/sup><\/span><\/p>\n

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Historically,\u00a0Parkinson\u2019s disease<\/span>\u00a0(<\/span>PD)<\/span>\u00a0was thought to\u00a0affect<\/span>\u00a0motor function,<\/span>\u00a0with studies and care largely focused on older Caucasian men.\u00a0However,\u00a0<\/span>i<\/span>t\u00a0has now<\/span>\u00a0been recognized that PD is a complex disorder with multifaceted presentations,<\/span>\u00a0including motor and non–<\/span>motor subtypes with a prodromal period (i.e.\u00a0<\/span>before patients meet current diagnostic criteria) of a decade or more.18,19<\/sup><\/span>\u00a0PD diagnoses are likely to increase dramatically over the next\u00a020<\/span>\u2013<\/span><\/span>30<\/span>\u00a0years,<\/span><\/span>\u00a0prompting some authors to suggest\u00a0that<\/span>\u00a0PD is an epidemic.20<\/sup><\/span>\u00a0Currently<\/span>, treatment is focused on symptomatic therapies, primarily for physical symptoms, using medications or devices that are tremendously beneficial in restoring motor function and allowing patients to function in daily life<\/span>.21<\/sup><\/span>\u00a0However, even with the best current therapies and wellness approaches, patients continue to\u00a0experience\u00a0<\/span>symptom<\/span>\u00a0progression and mounting disease burden over decades.\u00a0<\/span>It has been proposed that there should be an emphasis on early assessment to allow for effective psychosocial management from the point of diagnosis through to palliative care<\/span><\/span><\/span>.22\u201324<\/sup><\/span><\/span><\/p>\n

While disease modification is still aspirational,<\/span>\u00a0there may even be a role for wellness in counselling patients at risk for developing PD as predicted by genetic\u00a0testing\u00a0<\/span>or in the prodromal phase of PD.25<\/sup><\/span>\u00a0There have been similar proposals\u00a0for<\/span>\u00a0other neurodegenerative diseases,<\/span>\u00a0such as Alzheimer\u2019s disease.26<\/sup><\/span>\u00a0Wellness–<\/span>focused counsell<\/span>ing that incorporates motor, non-motor and mental health offerings delivered in a personalized manner\u00a0that is\u00a0<\/span>based on a bespoke dashboard of symptoms related to\u00a0<\/span>the PWP<\/span>\u00a0as a whole\u00a0<\/span>has been proposed. This approach builds upon the\u00a0<\/span>‘<\/span>dashboard vitals of PD<\/span>‘,<\/span>\u00a0which<\/span>\u00a0include comorbidities\/polypharmacy\u00a0and<\/span>\u00a0dental, vision, bone and gut health, which<\/span>\u00a0go beyond just motor and non-motor issues in PD.27<\/sup><\/span><\/p>\n

In the traditional medical paradigm, the patient is often a passive recipient of care,<\/span>\u00a0and healthcare interventions are sporadic and often in reaction to a symptom or complaint rather than proactive or preventative. This intermittent interaction with the healthcare system is compartmentalized and remains separate from the patient\u2019s day–<\/span>to–<\/span>day life. Patients often see their neurologist for only\u00a0one<\/span>\u00a015<\/span>\u2013<\/span>30<\/span>-minute<\/span>\u00a0appointment every\u00a06<\/span>\u00a0months<\/span>. In contrast, the wellness model places the patient at the centre<\/span>\u00a0of the care team,<\/span>\u00a0with goals defined\u00a0in accordance\u00a0with<\/span>\u00a0what<\/span>\u00a0they consider meaningful for their quality of life in their current social, economic and cultural context. The patient is responsible for making choices in their daily life (with individualized recommendations from their healthcare team) that influence their health outcomes, which cultivates self-agency (a feeling of control over actions and their consequences).\u00a0<\/span>This wellness pathway may\u00a0allow the\u00a0<\/span>patient\u00a0to\u00a0<\/span>thrive<\/span>,<\/span>\u00a0going beyond the traditional mitigation of individual symptoms and complaints. Lifestyle choices and actions are integrated into daily life and are not just intermittent; thus, seeking health becomes a continuous pursuit.<\/p>\n

Cultural and\u00a0d<\/span>iversity\u00a0c<\/span>onsiderations in\u00a0w<\/span>ellness<\/h1>\n

Cultural competence is defined as \u201cthe ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients\u201d<\/span>.28<\/sup><\/span>\u00a0A newer approach for practis<\/span>ing cultural humility,<\/span>\u00a0defined as \u201ca lifelong process of self-reflection and self-critique whereby the individual not only learns about another\u2019s culture, but one starts with an examination of her\/his own beliefs and cultural identities\u201d,<\/span><\/span>\u00a0has also been proposed.29<\/sup><\/span><\/p>\n

Although\u00a0<\/span>most healthcare disciplines are encouraged to provide culturally competent care as part of ethical practice, this is often not well translated into<\/span>\u00a0clinical practice. When making clinical recommendations, it is important to consider\u00a0the\u00a0<\/span>individual\u00a0patient’s\u00a0<\/span>cultural components,<\/span>\u00a0including age, gender, race and ethnicity, language, culture (including family-specific culture), socioeconomic status, sexual orientation and preference, religious\/spiritual affiliation, and disabilities and stage of\u00a0the\u00a0<\/span>disease.30<\/sup><\/span>\u00a0Geography also plays a large part in the delivery of care;<\/span>\u00a0health services\u00a0may be<\/span>\u00a0impacted by\u00a0internet<\/span>\u00a0connections and limitations for travel once patients become less mobile.\u00a0Figure 2<\/span>\u00a0is a summary of\u00a0the\u00a0<\/span>contributors to culturally competent or enabled care. Personal preferences and patient choice are key aspects of personalized medicine delivery and an integral part of the recently proposed\u00a0<\/span>‘<\/span>circle of personalized medicine<\/span>‘<\/span>\u00a0and the previously proposed\u00a0<\/span>‘<\/span>personalized medicine in non-motor PD<\/span>‘<\/span>.30,31<\/sup><\/span><\/p>\n

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The wellness model approach emphasizes the individual\u2019s environment and cultural context as key components in treatment.\u00a0<\/span>It\u00a0has also been\u00a0<\/span>noted that an individual\u2019s competing demands and values may vary in importance over time due to changing life\u00a0<\/span>circumstances and stages of\u00a0the<\/span>\u00a0disease.32<\/sup><\/span>\u00a0<\/span>Indeed<\/span>,\u00a0on\u00a0<\/span>any one day or week,<\/span>\u00a0the patient may experience a range of symptoms that may\u00a0either\u00a0<\/span>prevent them\u00a0from participating\u00a0<\/span>or enable them to participate in these lifestyle choices. When addressing holistic health, culturally informed care can guide further assessment and significantly change treatment recommendations and adoptability. For example, the wellness model from the First Nation\u2019s Tribe perspective (Indigenous people of North America)\u00a0<\/span>includes the land, nature, the ancestors and other nations\u00a0as model components<\/span><\/span>.33<\/sup><\/span>\u00a0A traditional healer or leader in a faith community may be critical to healthcare delivery.\u00a0Other\u00a0<\/span>a<\/span>rea<\/span>s in which cultural perspectives are particularly important to acknowledge include attitudes\u00a0toward<\/span><\/span>\u00a0age<\/span>ing, caregiving, dying and mental health,<\/span>\u00a0which can often be heavily stigmatized<\/span>.34\u201337<\/sup><\/span>\u00a0A vital component\u00a0in\u00a0<\/span>facilitating collaboration and trust between physicians and their patients is\u00a0for physicians to\u00a0<\/span>actively listen to patients about what they understand about their disease and what caused it. Some people may believe that the\u00a0person’s\u00a0<\/span>past actions may be the cause of their disease,<\/span>\u00a0which may contribute\u00a0to<\/span>\u00a0an additional burden of guilt or shame\u00a0for<\/span>\u00a0PWP.38<\/sup><\/span>\u00a0It is important to\u00a0<\/span>u<\/span>nderstand their values and beliefs while addressing their fears and concerns. This approach is especially important towards the end of life,<\/span>\u00a0when a patient\u2019s spiritual and religious beliefs may become even more central and impact\u00a0the\u00a0<\/span>preferred place of death or advanced care planning. These types of discussions are often encouraged in palliative care settings but definitely have value\u00a0in<\/span>\u00a0PD management throughout the disease trajectory.<\/span>\u00a0In some cultures, the decision regarding which family members are told the\u00a0<\/span>truth<\/span>\u00a0about medical issues and who can be engaged to help decide on treatment options can be overly complex.39<\/sup><\/span>\u00a0<\/span>Fostering open dialogue\u00a0with the patients\u00a0<\/span>allows physicians to appropriately apply their expertise in ways that positively impact patient outcomes. Positive holistic health management can be facilitated by several strategies.\u00a0Table 1<\/span>\u00a0displays some suggested methods for how clinicians can facilitate patient wellness.<\/p>\n

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The\u00a0r<\/span>ole of\u00a0h<\/span>olistic\u00a0h<\/span>ealth in\u00a0w<\/span>ellness<\/h1>\n

The conventional approach to care for PWP focuses largely on physical health and motor symptoms.<\/span>\u00a0Acceptance of non-motor issues as a significant contributor to quality of life in PWP is a newer concep<\/span>t.40<\/sup><\/span>\u00a0An emphasis on mental, psychosocial and spiritual health has been relatively undervalued to date,<\/span>\u00a0despite\u00a0<\/span>there\u00a0being<\/span>\u00a0many excellent reviews on<\/span>\u00a0motor and non-motor symptoms in PD.41,42<\/sup><\/span>\u00a0Here,<\/span>\u00a0we focus on the biopsychosocial aspects of health. The concept that mental health is more than the absence of psychiatric illness is consistent with wellness. Mental health,<\/span>\u00a0as defined by the\u00a0W<\/span><\/span>HO,<\/span><\/span>\u00a0is \u201c<\/span>a state of\u00a0well-being<\/span>\u00a0in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to\u00a0his or her\u00a0<\/span>communit<\/span>y\u201d<\/span>.43,44<\/sup><\/span>\u00a0Mental health is a collection of positive attributes maintained by psychological skills that help one adapt to the demands of life; it<\/span>\u00a0is a key determinant of wellness and should be proactively cultivated to counteract the burden of PD.41<\/sup><\/span>\u00a0<\/span>Additionally<\/span>, general medical health is also important,<\/span>\u00a0as issues such as dental, gut, bone health,<\/span>\u00a0poor vision, falls and frailty also need to be addressed to ensure that PWP can thrive.27<\/sup><\/span><\/p>\n

In PWP, mental health is challenged at several key intervals:<\/span>\u00a0at diagnosis,\u00a0at\u00a0<\/span>the\u00a0<\/span>onset of significant disability (<\/span><\/span>i.e.<\/span>\u00a0<\/span>the\u00a0<\/span>end of the\u00a0<\/span>‘<\/span>honeymoon period<\/span>‘<\/span>) and\u00a0at\u00a0<\/span>advanced disease when function and quality of life are severely decreased.\u00a0<\/span>Additionally,\u00a0it\u00a0<\/span>is now\u00a0possible\u00a0<\/span>to disclose a possible carrier mutation status and predict who may\u00a0develop\u00a0<\/span>PD from prodromal symptoms<\/span>.45<\/sup><\/span>\u00a0This\u00a0<\/span>at-risk<\/span>\u00a0or\u00a0<\/span>prodromal<\/span>\u00a0phase also\u00a0has\u00a0<\/span>potential mental health consequences,<\/span>\u00a0especially when<\/span>\u00a0the current paradigm does not include potential disease–<\/span>modifying strategies<\/span>.46<\/sup><\/span>\u00a0Optimal mental health can help PWP navigate these challenges and maintain a higher quality of life.<\/p>\n

Among the key resources for maintaining mental health are increasing resilience and supporting social connections. Often termed\u00a0\u2018<\/span>positive psychology\u2019<\/span>, interventions that promote these resources focus on\u00a0promoting\u00a0<\/span>wellbeing<\/span>\u00a0rather than reducing<\/span>\u00a0pathology.47\u201350<\/sup><\/span>\u00a0Resilience can be understood broadly as successfully adapting to adversity or flourishing despite adversity.51<\/sup><\/span>\u00a0Resilience was highlighted as a core area of focus by the WHO\u2019s European policy framework for health and wellbeing,<\/span>\u00a0which<\/span>\u00a0stated that for people to thrive, resilience must be strengthened.52<\/sup><\/span>\u00a0Several studies have identified a positive relationship between higher resilience and better quality of life. Ultimately, resilience has been described as one of the most important positive attributes\u00a0for<\/span>\u00a0facilitating the ability to adapt to change and maintain flexibility to meet new demands when faced with adversity.53<\/sup><\/span>\u00a0Resilience has not received much attention in PD.54,55<\/sup><\/span>\u00a0However, in other disease states,<\/span>\u00a0hope and resilience have been associated with better and more sustained coping with a chronic illness.56\u201358<\/sup><\/span>\u00a0In PD, higher resilience is correlated with\u00a0a\u00a0<\/span>lower disability, better quality of life and less apathy, depression, and fatigue,55<\/sup><\/span>\u00a0which suggests the need\u00a0for better\u00a0<\/span>cultivating<\/span>\u00a0these positive attributes in this chronic neurological disease.<\/p>\n

Social\u00a0c<\/span>onnection<\/h2>\n

Strong social networks, or connections with friends, family members and community, also contribute to wellness. Social isolation and loneliness have been associated with higher disease burden and decreased quality of life in PWP.14<\/sup><\/span>\u00a0PWP may develop\u00a0<\/span>a<\/span>\u00a0vicious cycle in which\u00a0they\u00a0<\/span>feel stigmatized and then become isolated,<\/span>\u00a0which can subsequently worsen their motor and non-motor symptoms, leading to further isolation and loneliness.\u00a0<\/span>Research on social connectivity has shown that it is important to create meaningful relationships not only\u00a0in\u00a0<\/span>intimate spheres (with a spouse or romantic partner) but also in relational (friends circle) and societal spheres with a community of people who have a similar purpose and interests (e.g.\u00a0<\/span>Parkinson\u2019s support groups<\/span>, religious groups<\/span>).59<\/sup><\/span>\u00a0<\/span>A supportive social network has been shown to prolong independent living, reduce morbidity and mortality, and improve coping ability in individuals with chronic diseases.60,61<\/sup><\/span>\u00a0In PD, social support has been linked with decreased stigma, depression and anxiety.62\u201364<\/sup><\/span>\u00a0It is also associated with better emotional\u00a0wellbeing<\/span>, communication, life satisfaction and positive affect.64,65<\/sup><\/span>\u00a0Specific activities, such as music and dance-based interventions,<\/span>\u00a0have been shown to improve emotional and social\u00a0wellbeing<\/span>\u00a0and should be considered\u00a0for<\/span>\u00a0increasing wellness\u00a0in<\/span>\u00a0<\/span>PWP<\/span>.15<\/sup><\/span><\/p>\n

PWP may experience a change in their social functioning due to PD symptoms (e.g.<\/span>\u00a0tremors<\/span>, facial masking and neuropsychiatric symptoms) or may withdraw from their social roles after PD diagnosis.66<\/sup><\/span>\u00a0Programme<\/span>s promoting social support networks\u00a0for\u00a0<\/span>PWP and participation in support groups can improve coping ability and quality of life in this population.67\u201369<\/sup><\/span>\u00a0<\/span>Social support is also helpful in facilitating accountability for lifestyle modifications;\u00a0<\/span>i<\/span>ndividuals completing interventions with a social support component demonstrate increased motivation to adhere to recommended behaviou<\/span>rs because they are accountable to someone else<\/span>.70<\/sup><\/span>\u00a0<\/span>Using social prescribing to proactively identify patients at risk for loneliness or depression and connecting them with social support is a promising new intervention that is<\/span>\u00a0gaining interest<\/span>.71<\/sup><\/span><\/p>\n

Lifestyle and\u00a0s<\/span>elf-management<\/h2>\n

From a global health lifestyle perspective, healthy behaviou<\/span>rs\u00a0such as<\/span>\u00a0exercise, a healthy diet (i.e.<\/span>\u00a0Mediterranean diet), staying hydrated and sleeping well at night\u00a0are key for\u00a0<\/span>PWP to thrive.12<\/sup><\/span>\u00a0Exercise is medicine in healthy age<\/span>ing and in PD.\u00a0<\/span>Exercising\u00a0for<\/span>\u00a030\u2013<\/span><\/span><\/span>60<\/span>\u00a0minutes<\/span><\/span>\u00a0per day,\u00a05<\/span>\u2013<\/span><\/span>7<\/span>\u00a0days<\/span>\u00a0per week,<\/span>\u00a0including cardio-based exercises,<\/span>\u00a0is beneficial for physical and mental health.72<\/sup><\/span>\u00a0<\/span>Having\u00a0the\u00a0<\/span>agency to choose how and which lifestyle modifications to implement may improve compliance.<\/p>\n

Self-agency<\/h2>\n

Essential to self-agency (i<\/span><\/span>.e.<\/span>\u00a0one\u2019s capacity to achieve desired goals) is a person\u2019s perceived ability to maintain some control over their own functioning and to meet situational demands,\u00a0<\/span>which is best understood as self-efficacy<\/span>.73<\/sup><\/span>\u00a0<\/span>It has been proposed that\u00a0<\/span>s<\/span>elf-efficacy positively affects<\/span><\/span>\u00a0behaviou<\/span>r via cognitive processes (e.g.<\/span>\u00a0planning for the future), motivational processes (e.g.<\/span>\u00a0commitment to desired goals) and controlling negative affective processes (e.g.<\/span>\u00a0fear of failing).12,73<\/sup><\/span>\u00a0Self-agency has been shown to improve quality of life.12<\/sup><\/span>\u00a0A recent review stated that the ultimate goal of health in PD is to support PWP in self-management and their ability to participate in activities that are meaningful to them.74<\/sup><\/span>\u00a0There has been a new focus on the role of patient participation in their own health,<\/span>\u00a0including\u00a0<\/span>adopting a healthy lifestyle that involves regular exercise and an appropriate diet<\/span>\u00a0and involving the PWP in medical decisions based on education and physician guidance.13<\/sup><\/span>\u00a0Wellness strategies to support holistic health include resilience training (e.g.<\/span>\u00a0improving the<\/span>\u00a0ability to manage physical, emotional and psychological health) and empowering patients by giving them a sense of agency through cognitive behaviou<\/span>ral therapy, coaching or mindfulness classes. These important tools should be available to all PWP,<\/span>\u00a0yet there has been a lack of study in this area. Furthermore, whilst<\/span>\u00a0a number of self-management strategies are promising, they need to include the care partner and peer support in their adoption.75<\/sup><\/span>\u00a0Patients want free (or affordable), transportable and understandable wellness strategies<\/span>\u00a0and\u00a0tools\u00a0<\/span>for<\/span>\u00a0empowering<\/span>\u00a0themselves to take control of their own health. Counselling and education on modifiable lifestyle choices,<\/span>\u00a0including sleep, diet, multimodal\u00a0and<\/span>\u00a0exercise-based strategies (including dance), mind\u2013<\/span>body\u00a0approaches\u00a0<\/span>and social connection should be available to all PWP from diagnosis.<\/p>\n

Historically, there has been a disproportionate focus on pharmacological interventions\u00a0for<\/span>\u00a0treating mental health issues in PWP. However, many patients would like an alternative to adding another pill.76<\/sup><\/span>\u00a0Latinx, Black, and other ethnic minorities,\u00a0as well as<\/span>\u00a0women, have been more interested in non-pharmacological approaches to treating PD,<\/span>\u00a0and this may serve as an entry point to building\u00a0a\u00a0<\/span>rapport with PWP prior to offering them pharmacological treatments.77<\/sup><\/span>\u00a0It has been proposed that there should be an emphasis on early assessment to allow for effective psychosocial management from the point of diagnosis through to palliative care.22\u201324<\/sup><\/span><\/p>\n

When prescribing these self-management strategies\u00a0to patients<\/span>, it is important to evaluate\u00a0their\u00a0<\/span>resource accessibility.\u00a0<\/span>The s<\/span>hame associated with a lack of access to these recommended lifestyle interventions has been described in the literature.78,79<\/sup><\/span>\u00a0<\/span>Clarke and Adamson highlighted how current exercise recommendations ignore individual social factors,<\/span>\u00a0including\u00a0the\u00a0<\/span>location or socioeconomic status.80<\/sup><\/span>\u00a0A lack of access to specific wellness prescriptions can induce feelings of shame for PWP, which<\/span>\u00a0can create additional barriers to achieving wellness. For example, not all individuals can afford gym memberships,<\/span>\u00a0and some<\/span>\u00a0may experience greater difficulty in maintaining a healthy diet if they are living in a food desert. Considering\u00a0the<\/span>\u00a0individual‘s<\/span>\u00a0access to resources could greatly impact patient wellness.<\/p>\n

In addition to shame related to the completion of clinician–<\/span>recommended intervention activities, PWP can experience shame related to their PD diagnosis.\u00a0<\/span>Previous research has identified that shame and embarrassment in PD can develop from PD symptoms, increasing disability and worsening body image.81<\/sup><\/span>\u00a0<\/span>This shame can contribute to several negative outcomes,<\/span>\u00a0such as social withdrawal, reduced quality of life and depression.81<\/sup><\/span>\u00a0Fortunately,\u00a0<\/span>s<\/span>ome interventions<\/span>\u00a0to reframe malada<\/span>ptive thinking\u00a0<\/span><\/span>have been successful in reducing shame in individuals with high shame and self-criticism.82<\/sup><\/span>\u00a0These interventions should be considered for PWP. The ultimate goal of any wellness strategy is to help the patient feel in control of their own health by making lifestyle choices that will help them to achieve a better quality of life and\u00a0a\u00a0<\/span>higher level of functioning. This goal should be achieved by giving a solid framework for clinicians,<\/span>\u00a0PWP and their loved ones to understand the progressive nature of PD and\u00a0the<\/span>\u00a0complexity of\u00a0its\u00a0<\/span>symptoms. Whilst<\/span>\u00a0educating and empowering PWP to live better\u00a0is important<\/span>, we do not want to add any additional shame or guilt if they\u00a0do\u00a0<\/span>not feel well enough to adopt these lifestyle changes.<\/p>\n

We have proposed a framework around which to care for PWP using lifestyle approaches. In the current healthcare environment,<\/span>\u00a0with a shortage of movement disorder neurologists worldwide, it is clear that all of this change cannot be the sole responsibility of the patient or the clinician,<\/span>\u00a0but rather\u00a0it lies\u00a0<\/span>in\u00a0a\u00a0<\/span>partnership. We propose engaging\u00a0a<\/span>\u00a0multidisciplinary team (<\/span><\/span>Figure 1<\/span>) and including support groups and community groups, clinicians,<\/span>\u00a0PWP and their loved ones as part of<\/span>\u00a0<\/span>a push for change<\/span><\/span>. Educating all providers who\u00a0are in contact with<\/span>\u00a0PWP from diagnosis is part of this message,<\/span>\u00a0including primary care physicians\u00a0and<\/span>\u00a0allied health professionals.\u00a0Using<\/span>\u00a0word of mouth,\u00a0the<\/span>\u00a0internet<\/span>\u00a0and social media\u00a0is key\u00a0<\/span>to circulating<\/span><\/span>\u00a0the\u00a0message behind\u00a0<\/span>a wellness prescription<\/span>,<\/span>\u00a0which includes<\/span>\u00a0the importance of exercise, diet and social connection as part of medicine,<\/span>\u00a0is key that can be accessed even without a physician referral.\u00a0This\u00a0<\/span>approach will\u00a0need<\/span>\u00a0the allocation of\u00a0<\/span>additional resources,<\/span>\u00a0including specialized training and education for healthcare providers,<\/span>\u00a0and<\/span>\u00a0the creation of\u00a0<\/span>accessible, community-based resources for PWP\u00a0in order to be implemented<\/span>.<\/p>\n

Conclusions<\/h1>\n

In summary, addressing holistic health using a wellness-based model invites a culturally informed, multidisciplinary approach, ranging from pharmacological and medical treatments to social, psychological and lifestyle interventions that can be chosen by the patient in concert with their healthcare team and family. The desired outcome may represent not just a decrease in overall physical dysfunction but an experience of thriving due to improved self-efficacy and social connection.<\/p>\n","protected":false},"excerpt":{"rendered":"

In modern medicine,\u00a0the concept of\u00a0wellness\u00a0is accompanied by many misconceptions.\u00a0Adopting wellness as a treatment\u00a0approach\u00a0has been well defined and\u00a0implemented in cardiovascular disease, diabetes and some types of cancer management\u00a0but has not yet been widely applied to neurologic diseases.1\u20135\u00a0The commercialization of the\u00a0wellness industry\u00a0has led to the misconception of wellness as expensive and only accessible to a niche population […]<\/p>\n","protected":false},"author":77788,"featured_media":17375,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","rank_math_lock_modified_date":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-53702","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","vocabulary_1-parkinsons-disease","journal-touchreviews-neurology"],"acf":{"wpcf-article_introduction":"","wpcf-article_abstract":"The concept of wellness has yet to be formally adopted in\u00a0Parkinson\u2019s disease<\/span>\u00a0(PD<\/span>) management despite its potential to improve quality of life. Currently, PD treatment is usually focused on symptomatic therapies for motor symptom relief using medications or devices. While\u00a0the\u00a0<\/span>focus on non-motor symptoms<\/span>\u00a0has increased in the last decade, it remains suboptimal. Future clinical practice should strive to incorporate the more holistic\u00a0<\/span>'<\/span>dashboard vitals of PD<\/span>',<\/span>\u00a0which<\/span>\u00a0include comorbidities\/polypharmacy\u00a0and<\/span>\u00a0dental, vision, bone, and gut health\u00a0and<\/span>\u00a0go beyond just motor and non-motor issues. Furthermore, recognizing and addressing the cultural context\u00a0of the patient\u00a0<\/span>and practis<\/span>ing\u00a0healthcare\u00a0<\/span>from a place of cultural humility can help decrease barriers to care and build trust. Promoting self-agency through personalized lifestyle interventions,<\/span>\u00a0such as healthy diet, exercise, sleep routines, mind\u2013<\/span>body approaches and social support,<\/span>\u00a0can make them more accessible and easier to maintain. Building upon the concept of personalized medicine in PD, wellness programme<\/span>s can proactively target non-motor issues\u00a0and\u00a0<\/span>mental and psychosocial health by enhancing resilience and supporting social connections. The desired outcome of a wellness approach extends beyond the traditional medical model to improve quality of life in a more enduring manner.","wpcf-article_keywords":"Culturally competent care, <\/span>mental health, <\/span>parkinson\u2019s disease, <\/span>quality of life, <\/span>social connection, <\/span><\/span>wellness<\/span>","wpcf-article_citation_override":"touchREVIEWS in Neurology<\/i>. 2023;19(1):8\u201313 DOI: https:\/\/doi.org\/10.17925\/USN.2023.19.1.8<\/a>","wpcf-compliance-with-ethics":"This article is an opinion piece and does not report on new clinical\u00a0data, or any studies with human or animal subjects performed by any of the\u00a0<\/span>authors.<\/span>","wpcf-article_disclosure":"Indu Subramanian has done some speaking for Acorda Therapeutics in the past 2 years. Gregory M Pontone has consulted for Acadia pharmaceutical inc. Kate Perepezko, Britt Stone and Ray K Chaudhuri\u00a0have no financial or non-financial relationships or activities to declare in relation to this article.<\/span>","wpcf-review_process":"Double-blind peer review.","wpcf-authorship":"The named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.","wpcf-article_correspondence":"Indu<\/span>\u00a0Subramanian<\/span><\/span>,\u00a0Department of Neurology, David Geffen School of Medicine, University of California<\/span>,\u00a0Los Angeles, 710 Westwood Blvd, Los Angeles, CA 90095<\/span>,\u00a0USA<\/span><\/span>;\u00a0ISubramanian@mednet.ucla.edu<\/span>","wpcf-article_support":"No funding was received in the publication of this article.","wpcf-open_access":"This article is freely accessible at touchNEUROLOGY.com. \u00a9 Touch Medical Media 2023","wpcf-article_pdf":"https:\/\/touchneurology.com\/wp-content\/uploads\/sites\/3\/2023\/04\/touchNEURO-19.1_pp8-13.pdf","wpcf-article_pdf-gated":false,"wpcf-article_doi":"","wpcf-old_nid":"","wpcf-article_image":"","wpcf-editor_choice":false,"wpcf-old_author_ids":"","wpcf-article_references":"

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81.<\/span>\u00a0Angulo<\/span>\u00a0J<\/span><\/span>,\u00a0Fleury<\/span>\u00a0V<\/span><\/span>,\u00a0P\u00e9ron<\/span>\u00a0JA<\/span><\/span>,\u00a0et al<\/span>.\u00a0Shame in Parkinson\u2019s disease: A review<\/span>.\u00a0J Parkinsons Dis<\/em><\/span>.\u00a02019<\/span>;9<\/span>:489<\/span>\u201399<\/span>.\u00a0DOI<\/span>:\u00a010.3233\/JPD-181462<\/span><\/p>\r\n

82.<\/span>\u00a0Gilbert<\/span>\u00a0P<\/span><\/span>,\u00a0Procter<\/span>\u00a0S<\/span><\/span>.\u00a0Compassionate mind training for people with high shame and self-criticism: Overview and pilot study of a group therapy approach<\/span>.\u00a0Clin Psychol Psychother<\/em><\/span>.\u00a02006<\/span>;13<\/span>:353<\/span>\u201379<\/span>.\u00a0DOI<\/span>:\u00a010.1002\/cpp.507<\/span><\/p>","wpcf-article_received_date":"20230223","wpcf-article_accepted_date":"20230418","wpcf-article_published_online":"20230510","wpcf-podcast":"","wpcf-ogg":"","wpcf-article_end_page":"","wpcf-article_start_page":"","wpcf-acknowledgements":"Figure 1 was created by\u00a0Miss Giulia Barone.<\/span>","wpcf-errata_pdf":"","wpcf-article_flipper_image":"","wpcf-corrected_online":null,"wpcf-supplementary_information":"","wpcf-article_highlight_pdf":"","data_availability":"Data sharing is not applicable to this article as no datasets were generated or analysed during the writing of this study.","digital_features":""},"_links":{"self":[{"href":"https:\/\/touchneurology.com\/wp-json\/wp\/v2\/posts\/53702"}],"collection":[{"href":"https:\/\/touchneurology.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/touchneurology.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/touchneurology.com\/wp-json\/wp\/v2\/users\/77788"}],"replies":[{"embeddable":true,"href":"https:\/\/touchneurology.com\/wp-json\/wp\/v2\/comments?post=53702"}],"version-history":[{"count":4,"href":"https:\/\/touchneurology.com\/wp-json\/wp\/v2\/posts\/53702\/revisions"}],"predecessor-version":[{"id":57087,"href":"https:\/\/touchneurology.com\/wp-json\/wp\/v2\/posts\/53702\/revisions\/57087"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/touchneurology.com\/wp-json\/wp\/v2\/media\/17375"}],"wp:attachment":[{"href":"https:\/\/touchneurology.com\/wp-json\/wp\/v2\/media?parent=53702"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/touchneurology.com\/wp-json\/wp\/v2\/categories?post=53702"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/touchneurology.com\/wp-json\/wp\/v2\/tags?post=53702"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}