With Shaking Hands: Aging with Parkinson's Disease in America's Heartland (review)

Recent advancement in the field of medicine has led to overall longevity of the U.S. population. It is expected that with longevity there will be a gradual increase in the incidence of senile diseases. Parkinson's Disease (PD) is one of the most common forms of progressive neurodegenerative disorder that affects the elderly population and sharply worsens people's quality of life, giving the health care workforce increasing responsibility to develop a concerted to effort to combat its challenges. The book under review, by Samantha Solimeo, a Health Research Science Specialist at the Center for Research in the Implementation of Innovative Strategies in Practice at the Iowa City VA Medical Center, has at its heart an ethnographic account of the experiences of eight adults in rural Iowa living with PD and their families, and also includes a primer on medical anthropology and one on PD itself. All 55 interview participants are individually introduced to the readers, increasing the vividness of the accounts presented.

Parkinson's Disease is a motor system disorder, resulting from the loss of dopamine-producing brain cells. Characterized by gradual onset in the form of subtly aberrant movements, PD lacks treatment that completely cures, halts, or retards its disabling motor and cognitive impairment. Medications are often prescribed for therapeutic action on the motor deficits in the hopes of better control of symptoms for those with this chronic condition. Solimeo writes well, and with affecting empathy, about life with PD. The book includes quantitative information as well as the ethnographic research findings.

According to the National Parkinson's Foundation, nearly one million people in the U.S. currently suffer from PD, with an additional 50,000 to 60,000 new cases diagnosed each year. Parkinson's disease normally affects people over age 50. Solimeo does a great job in highlighting the age specific differences in the perception of the disease. Summarizing, she notes that people in their 60s feel that PD accelerated their biological and social aging process, making them feel old before their time, while the PD patients in their 70s view PD as a mediator of aging. People stricken with PD in their 80s focus on ways that it interferes with daily routine.

Early definitive diagnosis is crucial for "longer disease-related life expectancy" (p. 51) in the case of PD. However, proper diagnosis of PD is extremely challenging since the symptoms of PD closely resemble those of normal aging process. Many people remain misdiagnosed or undiagnosed for about a year and half from the onset of PD. While family and friends may notice subtle abnormalities over a period of time, such abnormalities are often mistakenly seen as part of normal aging.

Solimeo explains that the current heath care system increases the likelihood that the PD-afflicted population will be neglected and underserved. Her extensive ethnographic inquiry into the daily lives of eight rural Iowans portrays real emotions and hard facts. General practitioners often are seen to not be knowledgeable about PD symptoms, leading to delayed diagnosis. Patients also hesitate to "waste the doctors' time" and do not ask for referral to a specialist. Furthermore, often the physicians do not spend enough time to explain the treatment options to facilitate informed decision. The four different ways the physicians break the news to the PD patients whose stories are recounted in the book demonstrate "well-intentioned and unintended offense" (p. 56). Patients report feeling like guinea pigs due to the often unavoidable practice of continuous switching of medications through lengthy trial-and-error process for better control of the disease. Nonetheless, this helpless group of people often signs up for clinical trials for experimental treatment modalities. They also settle for the treating neurologists who are often "busy," have little time to spare and rush them through the exam room with "their brusque and off-putting communication styles" (p. 57). Increased out-of-pocket expense for the medications, especially due to the...