For many patients with Parkinson’s disease, motor neurone disease (MND) and atypical Parkinsonian syndromes such as progressive supranuclear palsy, multiple system atrophy and corticobasal syndrome, management of oral secretions is a major problem.
Unfortunately, clinician awareness about saliva problems, it’s quality of life impact on patients and the treatment options available, is poor. As a result, patients are typically not proactively asked about sialorrhoea, and many patients are embarrassed to bring it up themselves.
It is essential that all patients experiencing sialorrhoea can access treatment. Sialorrhoea management needs to be incorporated into care pathways for people with Parkinson’s and related conditions to ensure that patients receive the management strategies available, which can be facilitated in a range of settings.
This document has been developed primarily as a resource for Primary Care Networks (PCNs) and Integrated Care Systems (ICSs) when setting up neurology care pathways. Sialorrhoea is not challenging to diagnose but does require healthcare professionals to proactively ask patients about their saliva so that they can access treatment for the problem condition.
Our analysis indicates that hospital admissions for people with sialorrhoea are rising significantly. Many of these are likely to be patients suffering from aspiration pneumonia as a result of sialorrhoea that has not been adequately addressed. No doubt many more patients are admitted who do not have a diagnosis of sialorrhoea formally recorded.
Sialorrhoea needs to be identified early so that patients can access the interventions that have life-changing consequences, as left untreated, sialorrhoea often has a detrimental impact on quality of life. Therefore, a systematic approach to identifying those at risk of sialorrhoea is needed.
This integrated care pathway resource has been created in a collaborative effort by a team of experts to support the detection and care of patients with sialorrhoea. We hope it will be a useful resource locally for both healthcare professionals and commissioners, to map the patient journey and ensure best practice care.