Problem: Mr. Newton, age 65, is seen by the home health nurse after a new diagnosis of Parkinson's disease. He has a history of hypertension, type 2 diabetes, and chronic obstructive pulmonary disease. He has a 65-pack year history of smoking; he quit smoking 10 years ago. He is 6′2″ tall and weighs 205 lb (BMI 26.32 kg/m2). On exam Mr. Newton has resting tremor bilateral upper extremities, his voice is soft with occasional slurring; his posture is stooped, and he takes short, shuffling steps that do not clear the floor and has minimal arm movement with ambulation. He has difficulty initiating movement. His gait is unsteady, and he uses a quad cane for assist. He must use the arms of the chair to stand, and it takes several attempts before he succeeds in standing. His partner of 15 years is present at the visit and states he now must assist Mr. Newton with dressing, as he can no longer button his shirts or grasp zippers. His medications include carbidopa/levodopa 10 mg/100 mg three times a day, metformin 500 mg twice a day, glipizide 5 mg twice a day, lisinopril/hydrochlorothiazide 10 mg/12.5 mg, and budesonide/formoterol 80 µg/4.5 µg 2 puffs twice