This study identified symptom clusters in individuals with PD and determined key factors influencing the impact of family support, self-care performance, and symptom clusters on quality of life.

The symptoms experienced by individuals with PD have been categorized into five major symptom clusters. The motor symptom cluster consisted of symptoms such as rigidity, tremor, and pain, limiting the physical independence of patients and significantly impacting their daily functioning and quality of life [9]. The daily activity cluster consisted of symptoms related to basic daily living abilities such as swallowing, personal hygiene, and walking. In patients with PD, the decline in activities of daily living worsens with disease progression and is closely linked to reduced independence and quality of life [17]. The emotional/affective regulation cluster encompasses emotional symptoms such as anxiety, depression, and apathy. These emotional issues are profoundly associated with dopamine transmission abnormalities in patients with PD [18]. The psychic/autonomic nervous system cluster consisted of autonomic nervous system and neuropsychiatric symptoms such as hallucinations, constipation, and urinary issues. These symptoms can serve as key indicators for assessing disease progression and treatment responsiveness [19]. The communication/sleep cluster consisted of sleep problems and speech disorders, which were closely linked to neurological and muscular abnormalities in individuals with PD [20].

An investigation into the interplay among symptom clusters, self-care performance, and family support in individuals with PD yielded findings of mutual significance.

First, a positive correlation was substantiated between symptom clusters. This finding suggests that PD symptoms exhibit a complex interrelationship rather than manifesting in isolation. Specifically, the correlation between the motor symptom cluster and the daily living cluster exhibited the most robust positive association. This finding suggests that the progression of motor symptoms has a greater adverse effect on daily living activities, thereby corroborating the conclusions of previous studies [9,20] that the advancement of PD leads to an exacerbation of functional limitations in patients. Therefore, a comprehensive cluster-based approach is more important than evaluating individual symptoms alone in the clinical assessment of individuals with PD. Among the various symptom clusters, the daily activity cluster, the emotional/affective regulation cluster, and the mental/autonomic nervous system cluster exhibited a negative correlation with self-care performance. This finding implies that as PD symptoms progress, patients’ self-care performance declines. This symptom cluster is distinguished by the presence of emotional symptoms, including depression, anxiety, and apathy. These findings align with prior research emphasizing the significance of managing non-motor symptoms in individuals with PD [18]. The daily activity cluster and the emotional/affective regulation cluster demonstrated a negative correlation with family support. This finding indicates that as functional and emotional symptoms intensify, patients may experience a diminution in awareness of family support, or family members may encounter limitations in their ability to provide adequate support due to the demanding nature of caring for patients [21]. Therefore, the establishment of a social infrastructure support system is essential to enhance the capabilities of family caregivers, taking into account the unique characteristics of each patient’s symptoms. A positive correlation was observed between family support and self-care performance. This finding aligns with the observations of prior studies [8,11], demonstrating that family support enhances self-management behaviors among patients. Therefore, educational and nursing interventions that engage family members as caregiving resources may be effective in enhancing self-care performance.

An analysis of the factors influencing quality of life in individuals with PD revealed that the motor symptom cluster, emotional/affective regulation cluster, dietary and daily living management domains within self-care performance, a spouse as the primary caregiver, and the timing of diagnosis emerged as significant factors in the final regression model.

Notably, during the hierarchical regression analysis process, the explanatory power increased approximately two-fold, from 36% to 71%, in the model that incorporated the symptom cluster compared to the model that only included general/disease characteristics, family support, and self-care. This finding underscores the importance of symptom clusters in the quality of life of individuals with PD, suggesting that the motor symptom cluster is directly associated with physical independence and represents a major factor in reduced quality of life. It supports existing literature indicating that motor symptoms are the strongest predictor of quality of life [10,18]. Additionally, the emotional/affective regulation cluster emerged as a second robust predictor, encompassing symptoms such as depression, anxiety, and apathy. This finding aligns with prior research [17] indicating that such emotional difficulties, in conjunction with physical discomfort, contribute to an overall diminished quality of life. It appears that nursing interventions for individuals with PD should take into account both the maintenance of motor function and emotional stability in a holistic manner. It is incumbent upon nurses to provide rehabilitation nursing care to prevent functional decline due to patients’ motor symptoms and to support independent living. Concurrently, nurses must conduct early assessments of emotional symptoms such as depression and anxiety. Interventions such as counseling and resource linkage are recommended to provide emotional support.

This finding corroborates the conclusions of previous studies [13,14], which indicated that structured daily living education effectively improves patients’ quality of life. This improvement is attributed to higher adherence to the diet and daily living management domains of self-care performance, which is linked to an enhanced quality of life. In particular, the daily living management items included in this study (basic activities such as washing one’s face, brushing teeth, eating, regular routine management, and hygiene management) reflect self-care performance abilities appropriate to individual functional levels, which can be interpreted as indicating that enhanced autonomy led to improved quality of life. Moreover, the findings on self-care performance in the dietary domain are consistent with prior research [21], suggesting that effective dietary management exerts an indirect influence on symptom alleviation and functional maintenance in individuals with PD. Dietary interventions are known to indirectly contribute to improved quality of life by enhancing drug absorption rates, improving intestinal function, alleviating constipation, and improving nutritional status [21]. In light of these findings, nurses are encouraged to devise personalized daily living and dietary management educational programs, meticulously customized to align with each patient’s unique symptom profile. Additionally, the implementation of a structured feedback mechanism is recommended to assist patients in enhancing their autonomy in self-care.

The quality of life declined when the primary caregiver was the spouse. The impact of PD is predominantly observed among individuals aged 60 and above [1]. Given that the primary caregiver is frequently the spouse, who is also advanced in age, challenges in providing care may emerge. This can lead to a decline in the quality of life for patients due to the limitations of care provided by elderly caregivers [21]. While this highlights the need for support systems within the community, it also suggests the necessity for different policy approaches to care related to aging. In the United States, the Parkinson’s Foundation offers online and in-person self-help groups and educational seminars for caregivers, with the objective of reducing the burden of caregiving [9]. Moreover, national and state-level caregiver support programs systematically provide short-term care services together, ensuring caregivers receive respite time [22]. However, although PD is designated as a special case of intractable disease in South Korea, providing institutional support such as a 10% reduction in patient copayment rates, costs like nursing care expenses are not covered, resulting in a significant financial burden [22]. While home-visit care services are provided through the Long-Term Care Insurance for the Elderly, access to these services remains insufficient for elderly spouses providing care [23]. Therefore, a comprehensive support system comprising expanded special benefits for the elderly, quantitative and qualitative expansion of home care services, and caregiver education and self-help groups should be established at the national policy level.

It has been known that PD typically takes an average of 2.75 years from the onset of symptoms to diagnosis [24]. While some patients receive a diagnosis within 1 year of symptom onset, others may require over a year. This delay is attributed to the diverse presentation of PD symptoms, complicating early disease recognition [24]. These findings support prior research [18] indicating that timely initiation of dopamine agonist therapy delays symptom progression during long-term management, thereby emphasizing the necessity of screening systems in primary care settings and communities. Currently, there is an absence of an officially administered simplified screening test specifically for PD in South Korea, and no active official campaigns are underway. Therefore, a substantial and diverse approach is essential. First, there is a need to enhance the ability of patients and their families to recognize symptoms through educational and disease awareness campaigns targeting the general public regarding non-motor symptoms and early signs of abnormal movement. Second, as overseas pilot programs utilize self-screening instruments for PD, such as the Baylor Functional Assessment Scale (BFAS) [25] and screening systems employing voice analysis-based mobile applications [26], it is imperative to establish a framework that enables the early detection of suspected symptom groups, primarily through community-based centers like public health centers. Finally, in the long term, the implementation of an integrated management system is imperative, as evidenced by the necessity of a national PD registry [27] to facilitate the early detection, monitoring, and intervention of patient populations.

Considering these findings, the following recommendations are put forward for the enhancement of nursing management and services.

Symptom cluster-based standard nursing assessment-planning-evaluation is required. A combined approach involving the MDS-UPDRS (Parts 1 and 2) and quality-of-life tools during the pre-admission and pre-hospitalization phases facilitates the early identification of high-risk groups (patients with high scores in the exercise, emotional/affective regulation cluster). This approach enables the simultaneous implementation of rehabilitation, fall prevention, pain management, and emotional symptom management [13,14,28]. The implementation of protocols that emphasize self-care, with a focus on dietary and daily management, is crucial. Additionally, the standardization of family-participatory education and coaching is indispensable to enhance the sustainability of self-care [8,11].

Furthermore, the establishment of a multidisciplinary integrated care pathway linking public health centers, long-term care facilities, medical institutions, and specialized nurses is necessary to provide patients with rehabilitation, nutrition, and digital management services, while concurrently supporting caregivers with burnout prevention, emotional support, and respite care [9,29]. At the national level, service accessibility should be improved through the introduction of early diagnosis infrastructure (e.g., BFAS, voice analysis) and the expansion of registration systems [25-27], in conjunction with realistic special billing provisions and adjustments to the coverage scope of long-term care insurance to facilitate caregiving and short-term care [22,23].

This study is a descriptive survey designed to identify symptom clusters in individuals with PD and to analyze the relationships among family support, self-care performance, symptom clusters, and quality of life to determine the key factors affecting quality of life. The findings of this study revealed that self-care performance and symptom clusters significantly impact the quality of life in individuals with PD. Based on these results, it is intended to propose tailored nursing interventions and future research strategies.

First, to standardize symptom cluster-based assessment in clinical nursing practice, the electronic health record for initial nursing assessment should incorporate a symptom cluster-based screening checklist. This enables the provision of tailored nursing care, particularly upon confirmation of increased severity in the exercise domain and the emotional/affective regulation cluster.

Second, community-based assessment programs should be implemented to enhance performance in the diet and daily living management domains of self-care performance. In particular, regular self-care ability assessments coupled with tailored feedback linked to systems such as long-term care insurance can strengthen patients’ self-care abilities, supporting them in setting their own management goals.

Third, the community should support the establishment of networks to provide multi-generational caregiver education, burnout management for elderly caregivers, and tailored disease management education to alleviate the burden on spouses. In conclusion, it is crucial to implement self-screening tools focused on public health centers or digital-based early screening systems to facilitate the early detection of PD. Furthermore, these measures should be accompanied by the intensification of awareness campaigns that emphasize the recognition of early symptoms and the disease itself.

Due to the convenience sampling conducted at a single institution and the self-reported survey methodology, the results of this study had limitations in generalizability. Future studies need to expand these findings through multicenter research involving various healthcare institutions and communities.