Abstract
Older patients often experience a loss of independent physical functioning during the course of an acute illness requiring hospitalization. This functional decline is often associated with adverse health outcomes for these patients. Acute Care for Elders (ACE) units were designed as a cost-efficient model of care to reduce the risks of functional decline and to enhance the patient’s physical functioning. The ACE Unit program includes a modification of the physical and therapeutic environments, an expanded role for bedside (relationship-based) nurses including bedside guidelines for patient care, interdisciplinary collaboration, and team-based planning for patient discharge to home. Three randomized clinical trials of the ACE unit demonstrate favorable outcomes of improved physical functioning of elderly patients, reduced hospital length of stay, fewer transitions to nursing facilities, higher patient and provider satisfaction with care, and reduced costs of hospitalization, compared to usual care. The ACE Unit program would likely improve quality of care and safety of all medically ill elderly patients.
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References
Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med. 1993;118:219–23.
Palmer RM, Landefeld CS, Kresevic D, Kowal J. A medical unit for acute care of the elderly. J Am Geriatr Soc. 1994;42:545–52.
Palmer RM, Counsell S, Landefeld CS. Clinical intervention trials: the ACE Unit. Clin Geriatr Med. 1998;14:831–49.
Covinsky KE, Palmer RM, Kresevic DM, Kahana E, Counsell SR, Fortinsky RH, Landefeld CS. Improving functional outcomes in hospitalized elders: lessons learned from an acute care for elders unit. Jt Comm J Qual Improv. 1998;24:63–76.
Kresevic D, Holder C. Interdisciplinary care. Clin Geriatr Med. 1998;14:787–98.
Landefeld CS, Palmer RM, Kresevic D, Fortinsky RH, Kowal J. A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. N Engl J Med. 1995;332:1338–44.
Palmer RM. Acute hospital care. Future directions. In: Yoshikawa TT, Norman DC, editors. Acute emergencies and critical care of the geriatric patient. New York: Marcel Dekker, Inc; 2000. p. 461–86.
Fortinsky RH, Covinsky KE, Palmer RM, Landefeld CS. Effects of functional status changes before and during hospitalization on nursing home admission of older adults. J Gerontol A Biol Sci Med Sci. 1999;54A:M521–6.
Covinsky KE, Palmer RM, Counsell SM, Pine ZM, Walter LC, Chren MM. Functional status before hospitalization in acutely ill older adults: validity and clinical importance of retrospective reports. J Am Geriatr Soc. 2000;48:164–9.
Palmer RM, Counsell SR, Landefeld CS. Acute care for elders units: practical considerations for optimizing health outcomes. Dis Manage Health Outcomes. 2003;11:507–17.
Kresevic DM, Landefeld CS, Palmer R, Kowal J. Managing acute exacerbations of chronic illness in the elderly. In: Funk SG, Tornquist EM, Champagne MT, Wiese RA, editors. Key aspects of caring for the chronically ill. New York: Springer; 1993.
Counsell SR, Holder CM, Liebenauer LL, Palmer RM, Fortinsky RH, Kresevic DM, Quinn LM, Allen KR, Covinsky KE, Landefeld CS. Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients: a randomized controlled trial of acute care for elders (ACE) in a community hospital. J Am Geriatr Soc. 2000;48:1572–81.
Covinsky KE, King JT, Quinn L, Siddique R, Palmer RM, Kresevic D, Fortinsky RH, Kowal J, Landefeld CS. Do acute care for elders units increase costs? A cost analysis using the hospital perspective. J Am Geriatr Soc. 1997;45:729–34.
Barnes DE, Palmer RM, Kresevic DM, Fortinsky RH, Kowal J, Chren MM, Landefeld CS. Acute care for elders units produced shorter hospital lengths of stays at lower costs while maintaining patients’ functional status. Health Aff. 2012;31:1227–36.
Fox MT, Persaud M, Maimets I, O’Brien K, Brooks D, Tregunno D. Effectiveness of acute geriatric unit care for elders components: a systematic review and meta-analysis. J Am Geriatr Soc. 2012;60:2237–45.
Flood KL, MacLennan PA, McGrew D, Green D, Dodd C, Brown CJ. Effects of an acute care for elders unit on costs and 30-day readmissions. JAMA Intern Med. 2013;173:981–7.
Hung WW, Ross JS, Farber J, Siu AL. Evaluation of the mobile acute care of the elderly (MACE) service. JAMA Intern Med. 2013;173:990–6.
Covinsky KE, Fortinsky RH, Palmer RM, Kresevic D, Landefeld CS. The relationship of depressive symptoms to health outcomes in acutely ill hospitalized elders. Ann Intern Med. 1997;126:417–25.
Covinsky KE, Kahana E, Chin MH, Palmer RM, RH F, Landefeld CS. Depressive symptoms and three year mortality in older hospitalized medical patients. Ann Intern Med. 1999;130:563–9.
Walter LC, Brand RJ, Counsell SR, Palmer RM, Landefeld CS, Fortinsky RH, Covinsky KE. Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA. 2001;285:2987–94.
Sands LP, Yaffe K, Covinsky K, Chren MM, Counsell S, Palmer R, Fortinsky R, Landefeld CS. Cognitive screening predicts magnitude of functional recovery from admission to three months after discharge in hospitalized elders. J Gerontol A Biol Sci Med Sci. 2003;58:37–45.
Lindenberger EC, Landefeld CS, Sands LP, Counsell SR, Fortinsky RH, Palmer RM, Kresevic DM, Covinsky KE. Unsteadiness reported by older hospitalized patients predicts functional decline. J Am Geriatr Soc. 2003;51:621–6.
Mehta KM, Pierluissi E, Boscardin J, Kirby KA, Walter LC, Chren MM, Palmer RM, Counsell SR, Landefeld CS. A clinical index to stratify hospitalized older patients according to risk for new-onset disability. J Am Geriatr Soc. 2011;59:1206–16.
Barnes DE, Mehta KM, Boscardin WJ, Fortinsky RH, Palmer RM, Kirby KA, Landefeld CS. Prediction of recovery, dependence or death in elders who become disabled during hospitalization. J Gen Intern Med. 2013;28:261–8.
Siu AL, Spragens LH, Inouye SK, Morrison RS, Leff B. The ironic business case for chronic care in the acute care setting. Health Aff. 2009;28:113–25.
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Palmer, R.M., Kresevic, D.M. (2014). The Acute Care for Elders Unit. In: Malone, M., Capezuti, E., Palmer, R. (eds) Acute Care for Elders. Aging Medicine. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-1025-0_5
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DOI: https://doi.org/10.1007/978-1-4939-1025-0_5
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