Knowledge translation interventions to sustain direct care provider behaviour change in long-term care: A process evaluation.

RATIONALE, AIMS, AND OBJECTIVES: Process evaluation can be used to understand the factors influencing the impact of knowledge translation (KT) interventions. The aim of this mixed methods process evaluation was to evaluate the processes and perceived outcomes of eight KT interventions that were used with healthcare aides (HCAs) to introduce a mobility innovation into their daily care practices. The study examined the perceived effectiveness of various KT interventions in sustaining daily performance of the sit-to-stand mobility innovation by HCAs with residents in long-term care. METHOD: In-person interviews were conducted with four leaders across three long-term care facilities. Seven focus groups with 27 HCAs were conducted across the three facilities. All participants were asked to rank the eight interventions involved in the trial according to their perceived effectiveness and, for the leaders, their perceived ease of implementation. Focus group and interview questions asked participants to discuss the relative merits of each KT intervention. Two research assistants coded all of the transcripts independently using content analysis. RESULTS: Both HCAs and their leaders perceived reminders, followed by discussion groups, to be the most effective KT interventions to sustain practice change. Healthcare aide champions were deemed least effective by both leaders and HCAs. Leaders identified both the focus group discussion and audit and feedback posters in the study as the most difficult to implement. Participants valued interventions that were strategically visible, helped to clarify misconceptions about the new care innovation, supported teamwork, and made visible the resident benefits of the care innovation. Logistical issues, such as staff scheduling and workload, influenced the perceived feasibility of the various KT interventions. CONCLUSIONS: Understanding how care staff in long-term care settings perceive KT interventions can inform the choice of future use of these interventions to move research evidence into practice.

Incidence and mortality of Parkinson's disease in older Canadians.

OBJECTIVE: To estimate the age-specific incidence of Parkinson's disease (PD) in elderly persons in the Canadian province of British Columbia (BC). All-cause and injury mortalities and relative risk of death for those persons with PD were also examined. METHODS: A historical cohort study was conducted using 5 provincial administrative databases from 1991/92 to 2000/2001. A series of algorithms based on the databases were created for case ascertainment of PD for persons 65 years or older. Crude and age-specific incidence and mortality rates were calculated using person-years of follow-up as the denominator. The impact of PD on all-cause and injury mortalities was examined using multivariate Cox regression models to provide adjusted hazard ratios. RESULTS: 10,910 incidence cases over 6,051,682 person-years of follow-up were identified. The crude annual incidence rate was 252 per 100,000 person-years. Over the nine year period, age standardized incidence for males ranged from 207 to 396 per 100,000 person-years and 127 to 259 per 100,000 person-years for females. Persons with PD were at a 43% greater risk of all-cause mortality and specifically, 51% greater risk of injury mortality. CONCLUSIONS: Incidence of PD is substantially higher in advanced age with age adjusted increases for both all-cause and injury mortalities. These findings also highlight falls as a primary factor for injury mortality in PD.

The burden of Parkinson disease (PD) and concomitant comorbidities.

The impact of PD on health status is substantial, yet the disease burden has not been clearly defined. Using a representative sample of the community-dwelling Canadian population, we examined the burden of PD and the burden of concomitant comorbidities. Health status was compared in 261 respondents with PD from the Canadian Community Health Survey to 111,707 respondents without PD using the Health Utilities Index Mark 3 (HUI3). Differences in HUI3 scores were evaluated and selected sociodemographic covariates adjusted in ANCOVA models. The impact of specific comorbidities on the health status of PD were evaluated using ANCOVA models. Adjusted mean overall HUI3 scores were significantly lower for respondents with PD (0.61 vs. 0.83, p<0.05). The largest differences in single attribute scores were observed for ambulation (-0.11, 95% confidence interval=CI=-0.16 to -0.06), dexterity (-0.11, CI=-0.19 to -0.03), and cognition (-0.10, CI=-0.18 to -0.02). Additional burden was seen when persons with PD also had urinary incontinence (-0.22, CI=-0.40 to -0.05) or arthritis (-0.17, CI=-0.30 to -0.04). PD has detrimental effects on both physical and mental health relative to the general population. The findings provide baseline population estimates of disease burden for PD.