The Problem with Standard Hospitalization for Older Adults
Traditional hospital units are optimized for treating specific illnesses but can inadvertently cause harm to older patients. Hospitalization is a major risk factor for functional decline in the elderly, leading to reduced mobility, loss of independence, and other complications. While the acute illness is being treated, seniors may experience a variety of negative outcomes, including:
- Delirium: Acute confusion resulting from infection, medication, or sleep deprivation.
- Falls: Increased risk due to deconditioning and an unfamiliar environment.
- Pressure ulcers: Risk increases with immobility and fragile skin.
- Malnutrition and dehydration: Occurs from poor appetite, difficulty eating, and missed meals.
- Incontinence: Can be exacerbated by reduced mobility and an unfamiliar environment.
This functional decline can lead to longer hospital stays, higher costs, and an increased likelihood of being discharged to a nursing home rather than returning home. The ACE model of care was developed specifically to counter these negative effects by taking a holistic, patient-centered approach to care.
The Core Principles of an ACE Unit
At its foundation, the ACE model of care is based on four key principles aimed at improving the hospitalization experience and outcomes for older adults:
- Patient-centered care: Treatment plans are aligned with the individual patient's specific health goals and preferences.
- Interdisciplinary team: Care is delivered by a specialized team of experts, not just a single physician.
- Early discharge planning: Planning for the patient's return home or to a suitable care setting begins immediately upon admission.
- Elder-friendly environment: The physical unit is adapted to maximize the patient's mobility and independence.
The Interdisciplinary ACE Team
One of the defining features of the ACE model is its use of a specialized interdisciplinary team (IDT). This team meets regularly to create and review a comprehensive care plan for each patient. A typical ACE team includes:
- Geriatricians and Hospitalists who manage the patient's overall medical care.
- Geriatric-trained Nurses and Nurse Practitioners who provide bedside care and conduct daily functional assessments.
- Physical and Occupational Therapists who focus on maintaining and restoring mobility and daily living skills.
- Pharmacists who review and optimize the patient's medication regimen to prevent harmful interactions and side effects (polypharmacy).
- Social Workers and Case Managers who assist with discharge planning and connecting patients with community resources.
- Dietitians who ensure patients receive adequate nutrition and hydration.
- Therapy Aides who encourage regular walking and activity throughout the day.
ACE Unit vs. Standard Hospital Unit: A Comparison
| Feature | ACE Unit | Standard Hospital Unit |
|---|---|---|
| Environment | Features include non-slip floors, grab bars, large clocks, and communal areas to promote orientation and mobility. | Standard features designed for efficient care delivery, not specifically for geriatric needs. |
| Care Model | Holistic, patient-centered care focused on preventing functional decline. | Illness-focused care, with potential for patient functional decline as a side effect. |
| Team | Interdisciplinary team (IDT) meets daily to create a coordinated care plan. | Care often siloed, with limited formal coordination between different specialties. |
| Rehabilitation | Emphasizes early and consistent mobilization, often starting on day one. | Mobility protocols may be delayed until a patient is close to discharge. |
| Outcomes | Lower rates of functional decline, delirium, and falls; shorter hospital stays; reduced readmission rates; and higher likelihood of returning home. | Higher risk of functional decline, longer stays, increased readmissions, and potential for discharge to a long-term care facility. |
| Discharge | Planning begins upon admission, involving the patient and family for a smoother transition. | Planning may be delayed, leading to a hurried and less effective transition. |
The Benefits of Acute Care of the Elderly
The evidence supporting ACE units demonstrates significant improvements in outcomes for older adults. For instance, randomized controlled trials and systematic reviews show that ACE units lead to:
- Reduced Functional Decline: Patients are less likely to experience a loss of independence in activities of daily living (ADLs).
- Shorter Lengths of Stay: Specialized, coordinated care helps to expedite recovery and discharge.
- Lower Hospital Costs: The efficiency of the ACE model often leads to reduced healthcare expenditures.
- Fewer Readmissions: A strong focus on discharge planning and preventative care helps reduce the likelihood of a return trip to the hospital.
- Decreased Nursing Home Transfers: More patients are able to return to their homes and communities following hospitalization.
Conclusion
The Acute Care of the Elderly (ACE) model represents a critical advancement in healthcare for a growing senior population. By acknowledging and proactively addressing the unique vulnerabilities of older adults, ACE units provide a system of care that is more effective and humane than standard hospitalization. The emphasis on interdisciplinary teamwork, a supportive environment, and early intervention for geriatric syndromes helps to ensure that seniors can recover from acute illness without sacrificing their long-term independence and quality of life. As the demographic trend of an aging population continues, the principles of the ACE model will become increasingly vital in ensuring high-quality, patient-centered care for our elders.
