Understanding the ACE Model of Care
The Acute Care for Elders (ACE) model is a specialized, patient-centered approach to hospital care designed for older adults. Unlike standard care, which focuses mainly on the primary illness, the ACE model recognizes the increased risk of functional decline, delirium, and other complications in older hospitalized patients. An ACE unit aims not only to treat the acute condition but also to preserve or restore the patient's physical and mental independence for a safer return home.
The ACE model is based on a holistic, coordinated, and proactive approach. Key aspects include a physical environment that supports mobility, a collaborative interdisciplinary team, early discharge planning, and comprehensive medical review.
The Core Components of an ACE Unit
Successful ACE units rely on several integrated elements:
- Prepared Environment: The unit's physical space is modified to enhance safety and promote independence. This includes features like non-slip flooring, handrails, large clocks and calendars, and elevated toilets. The environment is designed to be calm to help prevent delirium.
- Interdisciplinary Team (IDT): A diverse team of specialists works together collaboratively. This team typically includes a geriatrician, nurses (often with geriatric expertise), a clinical nurse specialist, a pharmacist, a social worker or case manager, and physical and occupational therapists. This ensures all aspects of a patient's health are addressed comprehensively.
- Early Discharge Planning: Planning for the patient's transition home begins upon admission. The IDT collaborates with the patient and family to identify needs, arrange community resources, and coordinate follow-up care for a smooth and safe discharge, which helps reduce readmissions.
- Patient- and Family-Centered Care: Patients and their families are actively involved in care decisions, ensuring their preferences and goals guide the process. This engagement can reduce stress and improve satisfaction.
The Interdisciplinary Team in Action
The interdisciplinary team's coordinated effort is fundamental to the ACE model. The team conducts daily rounds to assess patients and update care plans. Each member contributes specialized expertise:
- Geriatrician/Physician: Provides overall medical management, focusing on age-related health issues and complex conditions.
- Nurses: Offer continuous bedside care and implement protocols to support functional independence, monitoring mobility, nutrition, skin integrity, and cognitive status.
- Physical and Occupational Therapists: Work to improve patients' strength, mobility, and ability to perform daily activities.
- Pharmacist: Reviews medications to prevent inappropriate prescriptions, polypharmacy, and adverse drug reactions.
- Social Worker/Case Manager: Addresses social, emotional, and financial needs, assists with discharge planning, and connects patients with community resources.
Comparison: ACE Unit vs. Standard Medical Unit
| Feature | Acute Care for Elders (ACE) Unit | Standard Medical Unit |
|---|---|---|
| Patient Focus | Holistic, with emphasis on preventing functional decline and addressing geriatric syndromes. | Disease-centric, focused primarily on treating the acute illness. |
| Environment | Specialized and adapted with safety features like handrails, non-slip floors, and large clocks to reduce disorientation. | Standard hospital room environment, often with fewer modifications for senior safety and mobility. |
| Care Team | Interdisciplinary and collaborative; includes geriatricians, nurses, therapists, pharmacists, and social workers. | Multidisciplinary, but often siloed, with less coordinated communication across different specializations. |
| Discharge Planning | Begins immediately upon admission, with proactive coordination involving patients, families, and community resources. | Initiated closer to the discharge date, often leading to less comprehensive follow-up planning. |
| Key Goals | Restore or maintain independence, reduce complications like delirium and falls, and decrease readmissions. | Treat the medical condition to achieve clinical stability. |
| Effectiveness | Evidence shows reduced functional disability, shorter hospital stays, and lower costs in some studies. | Associated with a higher risk of functional decline and complications for older adults. |
The Benefits of the ACE Model
Research indicates that the ACE model provides significant advantages for older patients by maintaining function and preventing complications, leading to better outcomes and efficient use of resources. Key benefits include:
- Reduced Functional Disability: The focus on mobility and daily activities helps prevent the loss of independence often associated with hospitalization.
- Lower Risk of Institutionalization: Patients treated in an ACE unit are more likely to return home and less likely to be discharged to a long-term care facility.
- Fewer Complications: Proactive measures help reduce common risks like falls, delirium, and pressure ulcers in older patients.
- Improved Patient and Caregiver Satisfaction: The patient-centered approach and strong communication contribute to higher satisfaction levels.
- Cost-Effectiveness: Despite initial implementation costs, studies suggest ACE units can lower overall costs through shorter hospital stays and reduced readmissions.
Case Study: An Older Patient's Journey Through the ACE Unit
Consider an 80-year-old woman admitted with pneumonia. She is usually independent and uses a cane. In standard care, focus would be on treating the pneumonia, but prolonged bedrest might cause weakness, potentially leading to discharge to rehab. In an ACE unit, an interdisciplinary team would implement a different approach. A physical therapist would encourage daily activity to maintain strength. A pharmacist would review medications to minimize fall risk. A social worker would arrange home support. The environment would be optimized with safety features. This coordinated effort helps prevent functional decline, making a direct return home more likely after pneumonia treatment.
Conclusion
Acute care of the elderly, primarily through the ACE model, represents a vital shift towards a patient-centered approach for older adults. By creating a specialized environment and utilizing an interdisciplinary team, ACE units effectively mitigate common hospital risks for seniors, such as functional decline and delirium. This results in improved patient outcomes, greater independence, and a better quality of life after hospitalization. The ACE model offers a strong framework for healthcare systems to address the complex needs of their aging population, focusing on restoring health and well-being beyond just treating illness. This proactive and integrated system is a proven method for providing high-quality care to vulnerable older adults. The National Institutes of Health provides extensive research on the effectiveness of ACE units.
