Workforce unavailability in Parkinson's disease

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Excerpt

Parkinson's disease (PD) is the second most common neurodegenerative disease with a prevalence of 0.1–0.9% in the general population 1. Although the onset of symptoms may predate diagnosis up to several years, the peak incidence of PD is typically reported to be between 70 and 79 years of age 2. Consequently, many patients are retired at the time of diagnosis. A considerable portion of people with PD, however, have been diagnosed at a much younger age as the prevalence of PD is 41 per 100,000 in ages 40–49 years and 107 per 100,000 in ages 50–59 years 1. Several industrialized countries are currently facing challenges with aging populations, which can be managed by raising the lower age limit for retirement. It is therefore likely that it will get increasingly common to be diagnosed with PD during working age, which leads to a further increase in productivity losses due to PD 3.
For those who are part of the workforce, PD often leads to increasing difficulties with sustaining employment 4. In addition to loss of employment, other detrimental psychosocial factors such as stigma, marital discord, and depression are also known to be more common in persons with young‐onset PD 7, which highlights the challenges for individuals with PD to sustain a satisfactory working life.
Untreated persons with PD exhibit limitations in activities of daily living (ADL) function and self‐reported health status at an early stage of the disease 8. In a questionnaire study among people with PD of working age, 82% of those who worked full time and 92% of those who worked part‐time reported that PD had worsened their working capacity 9. The same study showed that full‐time employment without adjustment of work tasks is rare beyond the first two or three years of PD, while others have shown that PD typically leads to loss of employment within ten years 4.
One study of 13,400 people with PD and 53,600 controls indicated that persons subsequently diagnosed with PD exhibit increased medical spending and lower employment rates than controls as early as eight years prior to the diagnosis 10. In addition to being employed to a lesser extent than others of the same age, persons with PD miss an average of eight more work days per year due to health reasons 11.
A first step to help facilitate workforce participation for persons with PD is the identification of factors contributing to an early loss of employment. A two‐year randomized controlled study among employed people with PD found that L‐dopa and entacapone treatment was associated with lower absenteeism and—although not statistically significant—higher employment rates at the two‐year follow‐up than those randomized to L‐dopa and placebo treatment 12. This was hypothesized to be due to better effects on motor fluctuations and dyskinesias in the L‐dopa and entacapone group. Other studies have identified disease severity (Hoehn and Yahr stage [H&Y]) 9, depression, anxiety 13, and PD duration as predictors or contributing factors for workforce exit 5. In a post hoc analysis of two UK‐based studies, there were no significant differences in time to loss of employment between genders, types of work, rural vs urban environment, living with a partner or not, or having children living at home or not 4. The notion that the type of work does not seem to affect the time to workforce exit following the PD diagnosis is also supported by another study 6. However, at least two studies show that white‐collar workers and individuals with university education are able to continue their employment to a larger degree 5.
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