Parkinson’s disease (PD) significantly affects mortality in nursing homes by increasing the risk of death through a combination of motor and non-motor complications that worsen over time. People with Parkinson’s often experience progressive disability, cognitive decline, and complications such as falls and pneumonia, all of which contribute to higher mortality rates compared to those without the disease.
In nursing homes, residents with Parkinson’s disease face unique challenges that influence their survival. The disease’s hallmark motor symptoms—rigidity, slowness of movement (bradykinesia), tremors, and postural instability—lead to a high incidence of falls, which occur in about 45 to 68 percent of people with PD. These falls are three times more frequent than in healthy individuals and often result in serious injuries that increase morbidity and mortality. The risk of falls is compounded by the progressive loss of balance and muscle control, making nursing home residents with PD particularly vulnerable to fractures and other trauma that can hasten death.
Cognitive decline is another critical factor influencing mortality. Up to 70 percent of people with Parkinson’s eventually develop Parkinson’s disease dementia (PDD), which severely impairs executive function, memory, attention, and visuospatial abilities. Dementia in PD is associated with a sixfold increase in mortality risk over a ten-year period compared to those without PD. It also leads to greater dependence on caregivers and a higher likelihood of nursing home placement. In nursing homes, cognitive impairment complicates care, as residents may struggle to communicate needs, follow instructions, or participate in rehabilitation, which can accelerate physical decline and increase mortality risk.
Swallowing difficulties (dysphagia) affect over 80 percent of people with advanced Parkinson’s. This condition increases the risk of aspiration pneumonia, a leading cause of death in this population. Aspiration pneumonia occurs when food, saliva, or stomach contents enter the lungs, causing infection and respiratory failure. In nursing homes, where residents may already have compromised respiratory function and weakened immune systems, aspiration pneumonia is a common and often fatal complication.
Speech difficulties (hypokinetic dysarthria) also worsen with disease progression, making communication challenging and potentially delaying the recognition of medical emergencies or changes in health status. This can indirectly contribute to increased mortality by hindering timely intervention.
Hospitalization and immobility further impact mortality in nursing home residents with Parkinson’s. Studies show that patients with PD who remain active during hospital stays have significantly better outcomes, including shorter hospital stays and a higher chance of returning home rather than being discharged to hospice or dying shortly after discharge. Conversely, inactivity during hospitalization is linked to a 74 percent higher likelihood of death or discharge to hospice care. This highlights the importance of mobility and rehabilitation programs in nursing homes to reduce mortality risk.
The progression of Parkinson’s disease varies widely, but more severe subtypes with rapid progression have shorter survival times—on average, around 8 years post-diagnosis for the most aggressive forms. Milder forms may allow survival for 20 years or more, but the overall life expectancy is reduced compared to the general population. Younger age at onset tends to correlate with longer survival but also with prolonged disability.
Quality long-term care services in nursing homes can help mitigate some of these risks by providing multimodal rehabilitation, caregiver training, and environmental adaptations that promote independence and reduce falls. However, extended care needs often exceed what is covered by standard health insurance or Medicare, creating financial and logistical challenges for families and care providers.
In summary, Parkinson’s disease affects mortality in nursing homes through a complex interplay of motor disability, cognitive decline, increased risk of falls and injuries, swallowing difficulties leading to pneumonia, and complications from immobility. Effective management strategies that emphasize mobility, cognitive support, and prevention of complications are crucial to improving survival and quality of life for nursing home residents with Parkinson’s disease.
