Parkinson's Disease Medication Administration Timing Deviations and Contraindicated Medicine Use in Residential Aged Care: A Retrospective Cohort Study

Objectives

Parkinson's disease (PD) is a common condition among older people and requires tailored, time-sensitive pharmacologic therapy for optimal symptom management. No prior studies have examined the extent to which doses of time-critical PD medicines are delayed or missed in residential aged care (RAC) settings. We aimed to identify deviations in PD medication administration timing and the use of medicines that are contraindicated in PD.

Design

A retrospective longitudinal cohort study.

Setting and Participants

Twenty-three RAC facilities in New South Wales, Australia. Permanent residents aged ≥65 years who received PD medicines.

Methods

Routinely collected electronic data from January 1 to September 30, 2024, was used to investigate deviations in PD medication administration timing, defined as the difference between scheduled and actual administration times. We quantified the extent of dose administration timing deviation using 30-minute and 60-minute thresholds. The proportion of residents prescribed medicines contraindicated in PD, based on the Beers Criteria, was determined.

Results

A total of 202 permanent residents (7.9% of all residents) received PD medicines. All 202 residents experienced at least 1 instance of dose timing deviations of >30 minutes, and almost all (98%) experienced a deviation of >60 minutes during the 9-month study. Of 166,028 scheduled doses, 1.1% (n = 1776) were not administered and 72.8% of residents (n = 147) missed at least 1 dose. Of 164,252 total administered doses of PD medicines, 25.6% (n = 42,069) were given >30 minutes before or after the scheduled time, equivalent to 605.8 incidents of wrong timing per 1000 resident days (95% CI, 572.0–641.6). Contraindicated medicines were given to 12.4% of residents (n = 25) who received PD medicines. The most commonly administered contraindicated medicines were metoclopramide (9 of 25, 36%), risperidone (8 of 25, 32%) and aripiprazole (5 of 25, 20%).

Conclusions and Implications

Our study identified extensive deviations in dose timing of PD medicines in RAC. Implementing strategies to enhance adherence to prescribed schedules for time-critical treatments may improve symptom management for residents with PD and reduce additional negative health outcomes and associated health care costs.