Managing deterioration in older adults in care homes: a quality improvement project to introduce an early warning tool.

Many older adults living in care homes have complex health needs requiring comprehensive care. Early warning tools can help identify deterioration, but currently they are less often used in care homes. The aim of this quality improvement project was to introduce an early warning tool, the Significant 7, to facilitate identification and management of deterioration in care home residents. The plan, do, study, act (PDSA) method was used, and process mapping informed a tailored intervention. Introducing the tool had positive outcomes for residents and care staff. There was a reduction in the incidence of pressure ulcers and falls, and care staff were more confident in recognising resident deterioration. Next steps include scaling up the project to further examine how this early warning tool can improve resident, staff and organisational outcomes, in order to explore the potential use of the tool by community nurses with older people living at home.

Applying comprehensive geriatric assessment to investigate falls.

This is the second article in a short series that presents case study examples of the use of comprehensive geriatric assessment (CGA) in different clinical settings. CGA is a holistic assessment model designed to determine frail older people's medical and mental health status, as well as functional, social and environmental issues. When applied by nurses, it can enable individualised planning for health, safety and wellbeing. This article presents the case of an older man who had a three-month history of falls. After his most recent fall he was admitted to an emergency department, where examination identified no significant abnormal pathology, and subsequently to a nurse-led older person's clinic. The article describes how a CGA approach was adopted to assess the man, establish an underlying diagnosis of Parkinson's disease, and develop a personalised care plan to address immediate falls risk and long-term planning.

Early economic evaluation of the digital gait analysis system for fall prevention-Preliminary analysis of the GaitSmart system.

Objective: To develop an early economics evaluation (EEE) to assess the cost-effectiveness of the GS in reducing the RoF and FoF. Methods: A cost-effectiveness analysis (CEA) with a return on investment (RoI) estimation was performed. CEA used the most relevant parameters, such as increased gait speed and decreased FoF, to estimate the reduction in the RoF, the impact on health care resources used and financial implications for the National Health System in the United Kingdom. Outcomes were measured as incremental cost-effectiveness ratio per quality-adjusted life years (QALYs) gained based on the reduction of the RoF and FoF. Uncertainties around the main parameters used were evaluated by probabilistic sensitivity analysis. Results: The CEA results showed that the GS is a dominant strategy over the standard of care to improve the movements of older persons who have suffered a fall or are afraid of falling (incremental QALYs based on FoF = 0.77 and QALYs based on RoF = 1.07, cost of FoF = -£4479.57 and cost of RoF = -£2901.79). By implementing the GS, the ROI results suggest that every pound invested in the GS could result in cost savings of £1.85/patient based on the RoF reduction and £11.16/patient based on the FoF reduction. The probability of being cost saving based on the number of iterations were 79.4 percent (based on FoF) and 100 percent (based on RoF). Conclusion: The EEE supports the main hypothesis that the GS is an effective intervention to avoid falls and is potentially cost saving.