The Acute Care for Elders Unit Model of Care.

Robert Palmer

doi:10.3390/geriatrics3030059

Abstract

Older patients are at risk for loss of self-care abilities during the course of an acute medical illness that results in hospitalization. The Acute Care for Elders (ACE) Unit is a continuous quality improvement model of care designed to prevent the patient’s loss of independence from admission to discharge in the performance of activities of daily living (hospital-associated disability). The ACE unit intervention includes principles of a prepared environment that encourages safe patient self-care, a set of clinical guidelines for bedside care by nurses and other health professionals to prevent patient disability and restore self-care lost by the acute illness, and planning for transitions of care and medical care. By applying a structured process, an interdisciplinary team completes a geriatric assessment, follows clinical guidelines, and initiates plans for care transitions in concert with the patient and family. Three randomized clinical trials and systematic reviews of ACE or related interventions demonstrate reduced functional disability among patients, reduced risk of nursing home admission, and lower costs of hospitalization. ACE principles could improve elderly care in any acute setting. The aim of this commentary is to describe the ACE model and the basis of its effectiveness.

Highlights

The Acute Care for Elders (ACE) model of care was designed to reduce the incidence of functional disability of older adults occurring during hospitalization for acute medical illness [1]
The ACE unit allocated 15 beds to geriatric patients but only a fraction of patients were enrolled in the clinical trial
Physical environments are becoming more “ACE-like”, clinical clinical pharmacists are monitoring the prescribing of potentially inappropriate pharmacists are monitoring the prescribing of potentially inappropriate medications,medications, financial financial are incentives aretoinreduce place tohospital reduce hospital conditions are relatively common incentives in place acquiredacquired conditions that arethat relatively more more common in in older adults, older adults, and and planning for transitions ofiscare is more commonly performed

Summary

Introduction

The Acute Care for Elders (ACE) model of care was designed to reduce the incidence of functional disability of older adults occurring during hospitalization for acute medical illness [1]. The ACE intervention used complementary principles of continuous quality improvement and comprehensive geriatric assessment in developing a new system of care for acutely ill older adults [2]. A multi-dimensional intervention included four key elements: a physical environment designed to promote patient functional independence and safety, patient–centered care delivered at the bedside by registered nurses in collaboration with interdisciplinary providers, comprehensive discharge planning undertaken early in the hospitalization and informed by the interdisciplinary team, and medical care review to assure quality of medication prescribing and clinical management. Studies of the natural history of functional morbidity in hospitalized older patients revealed the loss of independence from baseline physical functioning to hospital discharge in the majority of older adults and highlighted the adverse consequences of hospitalization [5,6]. A patient-centered approach is facilitated by an interdisciplinary team notable for its skills at Geriatrics 2018, 3, 59; doi:10.3390/geriatrics3030059 www.mdpi.com/journal/geriatrics

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