Key Points

ACE Units are general medical units specifically for older adults. These units typically have the following components:

An interprofessional team: physician, advance practice nurse, physician assistant, physical therapist, occupational therapist, speech therapist, nutritionist, social worker, pharmacist and nurses.

Focus on functional ability: daily PT/OT starting on the day of admission

Discharge planning: starts on admission day with goal of returning to the community.

A thorough pharmaceutical review: usually in conjunction with a pharmacist to check dosages, therapeutic levels, side effects, and drug interactions

A prepared environment designed to facilitate physical and cognitive function: large clocks and calendars, handrails, raised toilet seats, and other environmental modification to assist the older patient.

  1. First started in 1989 at the University Hospitals of Cleveland
  2. Clinical and cost-effective benefits include:
    • Fewer medications at discharge
    • Reduced prevalence and duration of delirium
    • Decreased length of stay
    • Decreased re-admission rate
    • Decreased nursing home placement
    • Better functional capacity including improved ambulation and ability to perform instruments of daily living
    • Better pain satisfaction scores.
  3. Cost savings are realized by increased discharges to home versus long-term care, decreased length of stay, and decreased readmissions.

Files

Acute Care for the Elderly Handout

Complications of Hospitalization Video

Understanding Restraints and Restraint Alternatives Video

References

Ahmed, N.N. & Pearce, S. E. (2010). Acute Care for the Elderly: A Literature Review. Population Health Management:13 (4): 219-225.

Ahmed, N., Taylor, K., McDaniel, Y., Dyer, C.B. (2012). The role of an acute care for the elderly unit in achieving hospital quality indicators while caring for frail hospitalized elders. Population Health Management: 15(4): 236-240.

Flood, K., MacLennan, P., McGrew, D. , et al.(2013). Effects of an Acute Care for Elders Unit on Costs and 30-Day Readmissions. Journal of the American Medical Association, 173(11):981-987.

Fox, M,T., Sidani, S., Persaud, M., Tregunno, D., Maimets, I., Brooks, D., & O'Brien, K. (2013). Acute Care for Elders Components of Acute Geriatric Unit Care: Systematic Descriptive Review. Journal of the American Geriatrics Society: 61(6): 939–946.

Landefeld, C.S., Palmer, R.M., Kresevic, D.M., Fortnsky, R.H., & Kowal, J. (1995). A Randomized Trial of Care in a Hospital Medical Unit Especially Designed to Improve the Functional Outcomes of Acutely Ill Older Patients. New England Journal of Medicine; 332:1338-1344.