Indu Subramanian, MD

“One of the things that I’ve been excited to talk about with palliative care—and Janis M. Miyasaki, MD, MEd, FRCPC, FAAN, talked about this as well—is the sort of sense that the principles of palliative care can be used, not just at end of life, but throughout the disease course.”

Palliative care has emerged over the years as a majorly important phase of care for those with serious and lifelong illness, and within that field, a focus has recently been placed on neuropalliative care. This specialty focus aims to improve the quality of care for those with neurological disorders using the palliative care framework.

, Indu Subramanian, MD, director, VA Southwest Parkinson’s Disease Research, Education, and Clinical Centers, spoke to the development of this focus in neurology from the recognition of the care needs of individuals with these disorders, and offered an overview of some of the reasons why this approach is crucial to patient management and meeting their long list of unmet needs.

Her focus being on movement disorders, namely Parkinson disease (PD), Subramanian highlighted that the palliative care approach offers clinicians the ability to view patients in a more holistic way—fitting into the comprehensive care model quite nicely. For Subramanian, it’s like “thinking about the patient in the center, and all the things that matter to them” around them, making for “more of a unit of care needs.”

She also pointed clinicians to the newly formed 

International Neuropalliative Care Society

, which will be virtually holding its first annual conference November 4-6, 2021. The theme of the conference is “Taking Flight” which aims to celebrate the society’s beginnings and highlight the emerging prominence of the field.

Videos

The director of the VA Southwest Parkinson’s Disease Research, Education, and Clinical Centers spoke to the importance of utilizing palliative care principles in the regular care of Parkinson disease. [WATCH TIME: 7 minutes]

The Need for Palliative Care in Parkinson Disease: Indu Subramanian, MD

“That extra phone call to check-in or scheduling a virtual happy hour with someone that you know has been working nonstop and hasn’t had a break…can be helpful to just share the common human experience that we’re all going through.”

With the ongoing pandemic this year leading to rapid changes in both how patient care is delivered and how individuals can interact, the subject of loneliness has become an important topic in medicine. At the 

, Indu Subramanian, MD, and colleagues presented data from a survey study of more than 1700 patients with idiopathic Parkinson disease, which suggested that social isolation and loneliness may be risk factors for worsened disease severity.

Subramanian, who is the director of the VA Southwest Parkinson’s Disease Research, Education and Clinical Centers, and a staff member in the Department of Neurology at UCLA, spoke to 

 about how these findings provide perspective on the importance of patient-centric outcomes and measures—particularly in the case of Parkinson disease, which is anticipated to almost double in prevalence over the next few decades.

In this interview, Subramanian shared her insight into how social prescribing—the literal prescription of social interventions for patients—can play a key role in the care of lonely patients, not only in the Parkinson disease population but in the veteran population she sees regularly in the clinic and even in the clinician population. As well, she shared how in the times of COVID-19, the awareness around loneliness and its impacts on health, in general, is particularly relevant.

REFERENCE
Subramanian I, Mischley L, Farahnik J. Loneliness/Social Isolation as a Risk Factor for Worsened Parkinson Disease Severity. Presented at MDS Virtual Congress; September 12–16, 2020.

The director of the VA Southwest Parkinson’s Disease Research, Education and Clinical Centers explained how preventing social isolation—particularly in the time of COVID-19—can help prevent worsened disease states in patients. 

Indu Subramanian, MD: Preventing Social Isolation to Prevent Disease Worsening

“I think it’s quite important to care about what patients care about and be more patient-centered.”

, September 12–16, 2020, data from a survey study of more than 1700 patients with idiopathic Parkinson disease from the CAM Care PD study were presented that suggested that loneliness and social isolation can be risk factors for worsened disease severity.

The results, while enlightening, also provide some perspective on the importance of patient-centric outcomes and measures. For lead author Indu Subramanian, MD, director, VA Southwest Parkinson’s Disease Research, Education and Clinical Centers, and the Department of Neurology, UCLA, this is a critical part of improving the complete care of these patients. Particularly so with the future prevalence of Parkinson disease appearing to be constantly increasing in the coming years.

, Subramanian explained how social prescribing—the literal prescription of social interventions for patients—can play a key role in the care of lonely patients. She also detailed how conversations with patients and staying patient-focused with measures can improve the overall state of care for Parkinson disease.

REFERENCE
Subramanian I, Mischley L, Farahnik J. Loneliness/Social Isolation as a Risk Factor for Worsened Parkinson Disease Severity. Presented at MDS Virtual Congress; September 12–16, 2020.

The director of the VA Southwest Parkinson’s Disease Research, Education, and Clinical Centers explained how social prescribing can play a key role in the prevention of social isolation.

Indu Subramanian, MD: Social Prescribing for Patients With Parkinson Disease

“It’s such a differently connected way of thinking about health these days that is quite profound as a pivot of change. I’m excited to see what the future holds. I think we have an opportunity to really think outside that box and intervene in ways that we never have before.”

In the last decade or so, medicine as a whole has begun to trend toward a more comprehensive care model, and while that has led to the widespread introduction of multidisciplinary teams to offer care, it has also led to some more outside-the-box thinking about patient care. A major part of that thinking is predicated on focusing on and improving quality of life for patients with chronic disease, in part by taking advantage of patient-centered measures. For patients with diseases such as Parkinson disease, this level of comprehensive care is essential.

For Indu Subramanian, MD, director, VA Southwest Parkinson’s Disease Research, Education, and Clinical Centers, and Department of Neurology, UCLA, this has been a particularly important area of interest. Subramanian explained to 

 that as a trained movement disorder neurologist who also specializes in wellness and integrative medicine approaches, she’s looked for ways to use these practices to provide a more holistic approach to patients. At the 

, September 12–16, 2020, she presented data from a survey study of more than 1700 patients with idiopathic Parkinson from the CAM Care PD study that revealed that loneliness may have a great impact on disease severity.

All told, those data revealed that individuals who reported feeling lonely had higher PRO-PD scores, higher even than those for smoking and having a lot of stress. In contrast, exercising 7 days per week was as beneficial for patients as feeling lonely was detrimental. Having a lot of friends was also shown to be beneficial. In this interview, Subramanian discussed how these data suggest the importance of more comprehensive care for these patients.

The director of the VA Southwest Parkinson’s Disease Research, Education and Clinical Centers discussed how loneliness can impact Parkinson disease severity and how holistic approaches to care may help.

Indu Subramanian, MD

Articles

The Need for Palliative Care in Parkinson Disease: Indu Subramanian, MD

Indu Subramanian, MD: Preventing Social Isolation to Prevent Disease Worsening

Indu Subramanian, MD: Social Prescribing for Patients With Parkinson Disease

Indu Subramanian, MD: The Effect of Loneliness on Parkinson Disease Severity