Notable Contributors: Melanie Zuo, M.D. | Nasiya Ahmed, M.D.
Key Points:
ACE Units are general medical units specifically for older adults. These units typically have the following components:
- An inter-professional 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.
Additional ACE Unit Facts:
- First started in 1989 at the University Hospitals of Cleveland
- 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
- Cost savings are realized by increased discharges to home versus long-term care, decreased length of stay, and decreased readmissions.
Supplemental 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.