Understanding the Acute Care for Elders (ACE) Model
The Acute Care for Elders (ACE) model is a comprehensive, multidisciplinary approach to geriatric hospital care. It was developed in the 1990s to address the concerning trend of older patients leaving the hospital with greater disability than when they were admitted. The model shifts the focus from treating a single disease to caring for the whole person, with a primary goal of maintaining or restoring the patient's independence in daily living. By integrating key principles into a specialized unit or throughout the hospital, the ACE model helps improve patient outcomes, reduce complications, and decrease the risk of hospital readmission or long-term care placement.
The Four Core Principles of the ACE Model
The ACE model is structured around four core principles that guide the care team's actions and the design of the unit:
1. A Prepared Environment
ACE units feature physical environments specifically designed to prevent functional disability and maximize patient independence and safety. This includes mobility-friendly spaces, orientation aids, and comfortable amenities.
2. Patient-Centered, Interdisciplinary Care
This principle ensures care is respectful of individual patient needs and preferences. An interdisciplinary team, including a geriatrician, nurses, social workers, pharmacists, and therapists, meets daily for comprehensive care coordination and patient involvement in decision-making.
3. Early and Comprehensive Discharge Planning
Planning for the patient's transition begins on admission to ensure a smooth and safe transition home or to another facility. This involves coordinated transitions and assessment of post-hospital needs.
4. Medical Care Review with a Geriatrics Approach
Medical care is reviewed through a geriatric lens, focusing on appropriate medication management and early intervention for common geriatric syndromes like delirium and falls.
Comparison of ACE Model and Traditional Care for Elderly Patients
| Feature | ACE Model of Care | Traditional Hospital Care |
|---|---|---|
| Environment | Features include non-slip floors, handrails, good lighting, and communal spaces to promote mobility and reduce confusion. | Often a general medical-surgical unit, not specifically adapted for geriatric patient needs. |
| Care Team | Interdisciplinary, with daily rounds involving multiple specialists (geriatrician, PT, OT, pharmacist, social worker). | Multidisciplinary, where different specialists may operate in silos, with less communication and coordination. |
| Focus | Holistic and patient-centered, with a focus on overall functional independence and quality of life. | Disease-focused, concentrating primarily on treating the acute illness that caused hospitalization. |
| Discharge Planning | Begins on admission and is comprehensive, involving patient and family from the start. | Often occurs late in the hospital stay, leading to rushed and less coordinated transitions. |
| Patient Mobility | Encouraged and supported from the beginning of the hospital stay to prevent functional decline. | Prolonged bedrest is more common, which can lead to rapid deconditioning and loss of function. |
| Outcomes | Demonstrated to reduce complications, shorten hospital stays, and lower readmission rates. | Higher risk of functional decline, longer hospital stays, and increased readmission risk for older adults. |
Benefits and Outcomes of the ACE Model
Research consistently demonstrates that the ACE model provides significant benefits for elderly patients and healthcare systems. Studies show improved patient outcomes, including reduced risk of nursing home placement and lower healthcare costs. The model's focus on functional independence and comprehensive care enhances the quality of life for older adults.
Conclusion
The ACE model offers an evidence-based approach to improving hospital care for older adults. It shifts from a disease-focused approach to one that preserves functional independence and dignity. By utilizing a collaborative interdisciplinary team, a supportive environment, and proactive discharge planning, the ACE model shows how systemic changes can lead to better outcomes for vulnerable elderly patients. The principles of the ACE model are increasingly vital for high-quality geriatric care in an aging population.
