Origins and Core Philosophy of the ACE Model
Developed in the 1990s, the Acute Care for Elders (ACE) model arose from the observation that acutely ill older patients often left the hospital with a permanent decline in their ability to perform daily activities, even after their primary illness had been treated. This decline was attributed not just to their illness, but to the hospital environment and conventional care processes, such as prolonged bed rest and poorly coordinated care. The core philosophy of the ACE model is to counteract these “hazards of hospitalization” and restore patients to their baseline level of independence.
The ACE model represents a major cultural shift from a disease-focused approach to a holistic, patient-centered one. Instead of simply treating a single medical condition, the interdisciplinary team prioritizes the patient's overall functional status, cognitive abilities, and potential post-discharge needs from the moment they are admitted.
The Key Components of the ACE Model
The Acute Care for Elderly model is built upon four foundational pillars that work together to improve patient outcomes:
- Prepared Environment: The physical hospital unit is adapted to be more elder-friendly and less sterile, resembling a home-like setting. Features include non-slip floors, enhanced lighting, handrails, and large clocks and calendars to help with orientation and minimize confusion. This environment encourages mobility and reduces the risk of falls.
- Patient- and Family-Centered Interdisciplinary Care: A dedicated interdisciplinary team (IDT) provides coordinated care, with the patient and family included as central members of the decision-making process. The team includes bedside nurses, a geriatrician, pharmacists, social workers, and therapists who communicate closely to address the patient's holistic needs.
- Nursing-Initiated Protocols: Bedside nurses are trained in specific protocols to proactively manage common geriatric issues, including mobility, nutrition, hydration, and continence. This minimizes preventable problems like skin breakdown and delirium, which are common in older adults during hospitalization.
- Early Discharge Planning: Planning for the patient's transition from the hospital to home or another facility begins on the day of admission. This proactive approach ensures the patient has the necessary resources and support, such as physical therapy or home health services, to facilitate a smooth and successful transition.
The Role of the Interdisciplinary Team
Each member of the ACE interdisciplinary team plays a specific role in supporting the patient's recovery. This collaborative approach distinguishes it from the silo-based, multi-disciplinary care typical of traditional hospital settings.
- Geriatrician/Physician: Oversees the medical plan, reviews medication appropriateness, and provides specialized geriatric expertise to the team.
- Clinical Nurse Specialist/Geriatric Resource Nurse: Acts as a central point of contact and helps guide the implementation of care protocols at the bedside.
- Physical and Occupational Therapists: Conduct assessments and lead early mobilization efforts to prevent functional decline. They also provide recommendations for assistive devices and rehabilitation.
- Social Worker/Care Manager: Coordinates resources, identifies community support needs, and ensures family members are involved in the discharge planning process.
- Pharmacist: Reviews all medications to identify and reduce potentially inappropriate or high-risk prescriptions, a process known as polypharmacy.
Comparison of ACE vs. Traditional Hospital Care
| Feature | Acute Care for Elderly (ACE) Model | Traditional Hospital Care |
|---|---|---|
| Care Philosophy | Holistic and patient-centered, focusing on maintaining or restoring function and independence. | Disease-focused, concentrating primarily on treating the acute medical issue that led to hospitalization. |
| Environment | Specially prepared, elder-friendly unit designed to minimize confusion, prevent falls, and encourage mobility. | Standard hospital environment that is often sterile and can unintentionally contribute to functional decline. |
| Medical Team | Interdisciplinary team (IDT) that includes geriatricians, specialized nurses, therapists, and social workers. | Multidisciplinary team where each specialist focuses on their own discipline with less coordinated effort. |
| Discharge Planning | Begins on admission to ensure proactive and comprehensive planning for transition home or to rehab. | Often initiated later in the hospitalization, leading to hurried and less coordinated transitions. |
| Common Outcomes | Reduced length of stay, lower costs, fewer readmissions, and decreased functional decline. | Higher rates of readmission, increased risk of functional decline, and higher costs due to longer stays. |
Benefits and Outcomes of the ACE Model
Extensive research has demonstrated that the ACE model provides significant benefits for older patients. Studies consistently show that patients treated in ACE units have a reduced risk of functional disability, delirium, and accidental falls during their hospital stay. This focus on maintaining independence often results in a higher rate of patients returning home rather than being discharged to a nursing home or other long-term care facility.
From a hospital perspective, the ACE model has proven to be cost-effective. By improving patient outcomes and reducing complications, hospitals often see a shorter average length of stay and lower overall inpatient costs. These efficiencies benefit both the patient, by minimizing stress and promoting faster recovery, and the healthcare system, by optimizing resource allocation.
Conclusion
The Acute Care for Elderly model is an evidence-based, patient-centered approach that addresses the unique medical and functional challenges faced by older adults during hospitalization. By combining a prepared, elder-friendly environment with a cohesive interdisciplinary team and proactive planning, the ACE model significantly improves outcomes, reduces costs, and prioritizes the patient’s ability to return home with their independence intact. While barriers such as staffing and implementation costs exist, the documented benefits make it a superior standard of care for geriatric patients in the acute setting.
