Skip to main content
SpringerLink
Log in

Acute Care for Elders Units

Practical Considerations for Optimizing Health Outcomes

  • Practical Disease Management
  • Published:
Disease Management & Health Outcomes

Abstract

Older patients often experience a loss of independent physical functioning during the course of an acute illness that requires hospitalization. Although functional outcomes are not usually the focus of care in the hospital, they may be critical determinants of the quality of life, physical independence, cost of care, and prognosis among older patients.

Based on a conceptual model of the dysfunctional syndrome (functional decline associated with hospitalization) we developed, implemented and evaluated a multi-component intervention termed Acute Care for Elders (ACE), in hospital medical units of two urban hospitals. ACE is a model of care that combines the principles of geriatric assessment and quality improvement. The ACE intervention includes a prepared environment (environmental modification), patient-centered care (interdisciplinary assessment), interdisciplinary team rounds and planning for home, and medical care review. Results of randomized clinical trials support the effectiveness of ACE to improve outcomes of hospitalization for older patients. Improved functional status, lower risk of nursing home placement and higher levels of patient and professional satisfaction with care are achievable with ACE.

The challenges of establishing an ACE unit in community hospitals can be met through a systematic process of implementation and evaluation.

ACE is a multi-component intervention that is potentially transportable to other hospital units, with benefits for patients, health professionals and hospital administrators.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Table I

Similar content being viewed by others

References

  1. Popovic JR. 1999 National hospital discharge survey: annual summary with detailed diagnosis and procedure data. National Center for Health Statistics. Vital Health Stat 13 2001; Sep (151): i–v, 1-206

    Google Scholar 

  2. Hirsch C, Sommers L, Olsen A, et al. The natural history of functional morbidity in hospitalized older patients. J Am Geriatr Soc 1990; 38: 1296–303

    PubMed  CAS  Google Scholar 

  3. Sager MA, Rudberg MA. Functional decline associated with hospitalization for acute illness. Clin Geriatr Med 1998; 14: 669–79

    PubMed  CAS  Google Scholar 

  4. Landefeld CS, Palmer RM, Kresevic DM, et al. 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

    Article  PubMed  CAS  Google Scholar 

  5. Covinsky KE, Palmer RM, Fortinsky RH, et al. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc 2003; 51: 451–8

    Article  PubMed  Google Scholar 

  6. Palmer RM, Landefeld CS, Kresevic D, et al. A medical unit for the acute care of the elderly. J Am Geriatr Soc 1994; 42: 545–52

    PubMed  CAS  Google Scholar 

  7. Sager MA, Franke T, Inouye SK, et al. Functional outcomes of acute medical illness and hospitalization in older persons. Arch Intern Med 1996; 156: 645–52

    Article  PubMed  CAS  Google Scholar 

  8. Inouye SK, Peduzzi PN, Robinson JT, et al. Importance of functional measures in predicting mortality among older hospitalized patients. JAMA 1998; 279: 1187–93

    Article  PubMed  CAS  Google Scholar 

  9. Walter LC, Brand RJ, Counsell SR, et al. Development and validation of a prognostic index for one-year mortality in older adults after hospitalization. JAMA 2001; 285: 2987–94

    Article  PubMed  CAS  Google Scholar 

  10. Palmer RM, Counsell S, Landefeld CS. Clinical intervention trials: the ACE unit. Clin Geriatr Med 1998; 14: 831–49

    PubMed  CAS  Google Scholar 

  11. Sullivan DH, Sun S, Walls RC. Protein-energy undernutrition among elderly hospitalized patients: a prospective study. JAMA 1999; 281: 2013–9

    Article  PubMed  CAS  Google Scholar 

  12. Covinsky KE, Fortinsky RH, Palmer RM, et al. The relationship of depressive symptoms to health outcomes in acutely ill hospitalized elders. Ann Intern Med 1997; 126: 417–25

    PubMed  CAS  Google Scholar 

  13. Counsell SR, Holder CM, Liebenauer LL, et al. 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

    PubMed  CAS  Google Scholar 

  14. Kresevic DM, Counsell S, Covinsky K, et al. A patient-centered model of acute care for elders. Nurs Clin North Am 1998; 33: 515–27

    PubMed  CAS  Google Scholar 

  15. 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: 461–86

    Google Scholar 

  16. Covinsky KE, Palmer RM, Counsell SM, et al. Functional status before hospitalization in acutely ill older adults: validity and clinical importance of retrospective reports. J Am Geriatr Soc 2000; 48: 164–9

    PubMed  CAS  Google Scholar 

  17. Fortinsky RH, Covinsky KE, Palmer RM, et al. 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

    Article  Google Scholar 

  18. Covinsky KE, Palmer RM, Kresevic DM, et al. Improving functional outcomes in hospitalized elders: lessons learned from an acute care for elders unit. Jt Comm J Qual Improv 1998; 24: 63–76

    PubMed  CAS  Google Scholar 

  19. Counsell SR, Holder C, Leibenauer LL, et al. The ACE (acute care for elders) manual: meeting the challenge of providing quality and cost-effective care to older adults. Akron, Ohio: SUMMA Health System, 1998

    Google Scholar 

  20. Covinsky KE, King JT, Quinn L, et al. Do acute care for elders units increase costs? A cost analysis using the hospital perspective. J Am Geriatr Soc 1997; 45: 729–34

    PubMed  CAS  Google Scholar 

  21. Inouye SK, Foreman MD, Mion LC, et al. Nurses’ recognition of delirium and its symptoms: comparison of nurse and researcher ratings. Arch Intern Med 2001; 161: 2467–73

    Article  PubMed  CAS  Google Scholar 

  22. Bogardus ST, Towle V, Williams CS, et al. What does the medical record reveal about functional status? A comparison of medical record and interview data. J Gen Intern Med 2001; 16: 728–36

    Article  PubMed  Google Scholar 

  23. Rubenstein LZ, Josephson KR, Wieland GD, et al. Effectiveness of a geriatric evaluation unit: a randomized clinical trial. N Engl J Med 1984; 311: 1664–70

    Article  PubMed  CAS  Google Scholar 

  24. Cohen HJ, Feussner JR, Weinberger M, et al. A controlled trial of inpatient and outpatient geriatric evaluation and management. N Engl J Med 2002; 346: 905–12

    Article  PubMed  Google Scholar 

  25. Inouye SK, Bogardus ST, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999; 340: 669–76

    Article  PubMed  CAS  Google Scholar 

  26. Inouye SK, Bogardus ST, Baker DI, et al. The hospital elder life program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital Elder Life Program. J Am Geriatr Soc 2000; 48: 1697–706

    PubMed  CAS  Google Scholar 

  27. Rizzo JA, Bogardus ST, Leo-Summers L, et al. Multicomponent targeted intervention to prevent delirium in hospitalized older patients: what is the economic value? Med Care 2001; 39: 740–52

    Article  PubMed  CAS  Google Scholar 

  28. Reuben DB, Borok GM, Wolde-Tsadik G, et al. A randomized trial of comprehensive geriatric assessment in the care of hospitalized patients. N Engl J Med 1995; 332: 1345–50

    Article  PubMed  CAS  Google Scholar 

  29. Naylor MD, Brooten D, Campbell R, et al. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA 1999; 281: 613–20

    Article  PubMed  CAS  Google Scholar 

  30. Rich MW, Beckham V, Wittenberg C, et al. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med 1995; 333: 1190–5

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

During preparation of this manuscript there were no sources of funding used. However, the research that is described in this manuscript was supported by various sources. Research was supported in part by grants from the John A. Hartford Foundation in New York and the Summa Health System Foundation in Akron, Ohio, USA. Dr Landefeld is supported in part by a Geriatrics Academic Leadership Award (AF00912) from the National Insitute of Aging.

Author information

Authors and Affiliations

  1. Section of Geriatric Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio, 44195, USA

    Robert M. Palmer M.D., M.P.H. (Head, Associate Clinical Professor)

  2. Case Western Reserve University, Cleveland, Ohio, USA

    Robert M. Palmer M.D., M.P.H. (Head, Associate Clinical Professor)

  3. Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA

    Steven R. Counsell

  4. University of California San Francisco, San Francisco, California, USA

    Seth C. Landefeld

Authors
  1. Robert M. Palmer M.D., M.P.H.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven R. Counsell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seth C. Landefeld
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert M. Palmer M.D., M.P.H..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Palmer, R.M., Counsell, S.R. & Landefeld, S.C. Acute Care for Elders Units. Dis-Manage-Health-Outcomes 11, 507–517 (2003). https://doi.org/10.2165/00115677-200311080-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00115677-200311080-00004

Keywords

Search

Navigation