## Breadcrumb - [Home](/) - [Resources & Support](/resources-support) - [For Care Partners](/resources-support/carepartners) ## Breadcrumb - [Home](/) - [Resources & Support](/resources-support) - [For Care Partners](/resources-support/carepartners) # Advanced Parkinson’s ## 💡 Quick Summary - Advanced Parkinson’s disease occurs when a person is no longer physically independent and requires help with daily activities. - Cognition changes, including thinking difficulties and [dementia](/understanding-parkinsons/non-movement-symptoms/dementia "Dementia"), are common in advanced PD and may affect communication and memory. - Care strategies should be personalized and supported by a local [care team](/living-with-parkinsons/finding-care/building-your-team "Building Your Care Team"), including medical professionals and community resources. - Key areas of focus include managing movement and communication challenges, adjusting [daily routines](/living-with-parkinsons/management/activities-daily-living "Activities of Daily Living") and planning for end-of-life care. ![Advanced Parkinson’s](/sites/default/files/styles/no_sizing/public/images/advancedparkinsons.jpg?itok=IyOyJvPk) There is no single definition of “advanced” Parkinson’s disease (PD). While the disease progresses differently from person to person, there are several scales healthcare professionals use to measure the disease is and its progression. In general, when a person with Parkinson’s is no longer physically independent, the disease is considered advanced. This means that the person has problems with mobility and cannot complete activities of daily living without help. Cognition changes, specifically [dementia](/understanding-parkinsons/non-movement-symptoms/dementia "Dementia"), are also a hallmark of advanced PD. Suggestions and tips for helping your loved one manage advanced PD should always be modified to best suit both of your needs. We strongly recommend building a care team in your local area to help you on your caregiving journey. For referrals, talk to your loved one’s PD doctor or call our [Helpline](/resources-support/helpline "Helpline") at 1-800-4PD-INFO (1-800-473-4636). ## Get Informed ### Activities of Daily Living Advanced Parkinson’s often complicates daily activities. We highlight tips to help you adjust your home and lifestyle. [EXPLORE OUR TIPS](/resources-support/carepartners/advanced/daily-living) ### Thinking Changes & Dementia A broad range of thinking and memory changes can occur in Parkinson’s. How can you help your loved one along the way? [LEARN MORE](/understanding-parkinsons/non-movement-symptoms/dementia) ### Planning for End of Life As difficult as it is to discuss, it is important for you and your loved one to plan for and talk about options end-of-life plans. [FIND OUT MORE](/resources-support/carepartners/advanced/end-life) ## Addressing Challenges in Advanced Parkinson's - ### Movement Challenges As Parkinson’s advances, your loved one will likely need greater hands-on assistance. Talk to your loved one’s PD doctor for a referral for a physical therapist (PT). PTs can provide an evaluation and teach you safe and effective ways to safely help while avoiding injury. - **Help ensure your loved one is regularly exercising.** [Exercise](/living-with-parkinsons/treatment/exercise "Exercise") helps people with Parkinson’s stay strong and flexible, improve circulation and helps maintain the ability to do daily tasks. [Online classes](/resources-support/online-education/pdhealth "PD Health @ Home") and in-person chair exercise classes can be worth exploring. - **Ask an expert.** Work with a physical or occupational therapist to design an exercise program tailored to your loved one’s particular needs and challenges. - **Build a routine.** Encourage regular movement of arms and legs as part of the daily routine. It may be necessary to split exercise into several short sessions, or to incorporate a few exercise activities during dressing or bathing tasks. Use small, inexpensive equipment like balls or balloons throughout the day to help stimulate movement, and practice repeating common words or phrases, focusing on maintaining loudness in between tasks or activities. - **Think big.** Encourage your loved one to focus on maintaining large, exaggerated motions whenever possible. - **Stay active together.** Get your loved one up and walking with assistance whenever possible to maintain leg strength and strong, healthy bones. Engage in activity with your loved one through music (dancing, marching, singing, swaying, etc.). Encourage participation, when possible. Give just enough assistance as required. - ### Communication Challenges In addition to the natural changes like hearing loss and cognitive changes that come with aging, it can be even more challenging to communicate when your loved one has advancing Parkinson’s. A person with Parkinson’s is more than 33 percent more likely to experience a conversation breakdown due to [non-movement PD symptoms](/understanding-parkinsons/non-movement-symptoms "Non-Movement Symptoms") — such as changes to speech, decreased facial expression (also called "facial masking") and anxiety. - **Work on speech**. Ask your doctor for a referral to a speech pathologist to design a breathing and speech practice program. - **Pick times of day to have specific conversations**. Consider [medication](/living-with-parkinsons/treatment/prescription-medications "Prescription Medications") times and times when the person with PD is less prone to [fatigue](/understanding-parkinsons/non-movement-symptoms/fatigue "Fatigue"). - **Eliminate distractions**. It helps to see and hear as you communicate. Turn off the TV and sit face to face to make out mouth movement and voice loudness. - **Remain calm**. Resist raising your voice or giving up. People may withdraw and become nervous with an elevated voice. Stay engaged and be persistent. You will find strategies that work for you. - **Negotiate preferences ahead of time**. Care partners who are often just trying to help can talk over or interrupt their loved one. This often leads to unintentional negative effects and can end up taking away from identity and voice. ASK for permission to speak for them or fill in information. - **Acknowledge conversation difficulties**. Verify that you understood the message. Discuss openly the type of help needed and how you would like to give and receive it. ### For Care Partners Read our care partner tips for Activities of Daily Living. [LEARN MORE](/resources-support/carepartners/advanced/daily-living) ## Related Materials Fact Sheets ### [ My Parent Has Parkinson's. What Does It Mean? ](/library/fact-sheets/parent-has-parkinsons) [Read Now](/library/fact-sheets/parent-has-parkinsons) Fact Sheets ### [ Intimacy and PD ](/library/fact-sheets/intimacy) [Read Now](/library/fact-sheets/intimacy) Fact Sheets ### [ Impulse Control ](/library/fact-sheets/impulse-control) [Read Now](/library/fact-sheets/impulse-control) ## Related Blog Posts ![Older couple walking through a park](/sites/default/files/styles/500x360/public/images/Caregiver-month-blog.jpg?h=ed9ce7df&itok=7SfvYcAD) Caregiving Topics ### [ 3 Essential Resources for 3 Different Kinds of Care Partners ](/blog/care/essential-resources) READ NOW ![A woman in a wheelchair sits in front of a wall of windows as a man tenderly cares for her](/sites/default/files/styles/500x360/public/images/Advanced%20PD%20blog.png?h=ed9ce7df&itok=_-qn1xSw) Caregiving Topics ### [ Advanced Parkinson’s Care: Practical Ways to Help Your Loved One ](/blog/care/advanced-parkinsons-care) READ NOW ![Caregiver Burnout](/sites/default/files/styles/500x360/public/images/Blog%20Previews%20%282%29_0.png?h=9105c3fe&itok=8HZLc9Gx) Caregiving Topics ### [ Finding Balance: 8 Tips for Avoiding Caregiver Burnout ](/blog/care/avoiding-burnout) READ NOW ### Celebrate a Loved One Start a tribute page in honor of a loved one living with Parkinson’s or celebrate their legacy by creating a memorial fundraiser. [START A TRIBUTE PAGE](https://secure3.convio.net/prkorg/site/TR?fr_id=5906&pg=entry) ### Connect with Others Explore our PD Conversations discussion groups to find answers or talk to others going through similar experiences. [Join Now](https://www.pdconversations.org/) - Share on Facebook - Share on X - Share on LinkedIn