Acute Care for Elders Components of Acute Geriatric Unit Care: Systematic Descriptive Review

Abstract

1 Structured Abstract OBJECTIVES. To describe the Acute Care for Elders (ACE) model components implemented as part of acute geriatric unit care and explore the association of each ACE component with outcomes of reduced iatrogenic complications, functional decline, length of hospital stay, nursing home discharges, and costs and increased discharges home. DESIGN.Systematic descriptive review of 32 articles, including 14 trials reporting on the implementation of ACE components or the effectiveness of their implementation in improving outcomes. Mean effect sizes (ESs) were calculated using trial outcome data. Information describing implementation of the ACE components in the trials was analyzed using content analysis.SETTING. Acute care geriatric units. (N= 6,839) with an average age of 81 years. PARTICIPANTS. Acutely ill or injured adults INTERVENTIONS.Acute geriatric unit care was characterized by the implementation of one or more ACE components: medical review, early rehabilitation, early discharge planning, prepared environment, patient-centered care.MEASUREMENTS. Falls, pressure ulcers, delirium, functional decline, length of hospital stay, discharge destination (home or nursing home), and costs. RESULTS.Medical review, early rehabilitation, and patient-centered care, characterized by the implementation of standardized and individualized function-focused interventions, had larger standardized mean ESs (all ES = .20) averaged across all outcomes, than did early discharge planning (ES = .17) or prepared environment (ES = .11).CONCLUSION. Specific ACE component interventions of medical review, early rehabilitation, and patient-centered care, appear to be optimal for overall positive outcomes. These findings can 2 help service-providers design and evaluate the most effective ACE model within the contexts of their respective institutions to improve outcomes for acutely ill or injured older adults. The aims in this systematic descriptive review were to describe ACE components implemented as part of acute geriatric unit care in terms of objectives, ACE interventions, dose, and approach, and to explore the association of each ACE component with the outcomes of reduced iatrogenic complications, functional decline, length of hospital stay, nursing home discharges, and costs and increased discharge home. 4 METHODSThis was a systematic descriptive review of the trials reported in a recent meta-analysis. 7 For the first aim, conceptual, clinical, and empirical articles that provided accounts of how the ACE components were designed or implemented in these trials were reviewed. For the second aim, trial outcome data were used to calculate the mean effect size (ES) associated with each ACE component. Components associated with larger ESs were interpreted as having larger contributions to the outcomes. Selection CriteriaSelection criteria for trials included in this descriptive review have been previously reported. 7Conceptual, clinical, and empirical articles that contained supplemental information about one or more ACE comp...

Geriatrics Evaluation and Management in the Veterans Administration– An Historical Perspective

“…These individual, focused interventions appear to have a greater effect than either discharge planning processes, or environment of care. 2 Since its inception in the 1970s, there has been an evolution of VA geriatric evaluation and management over time and resources have become more available in long-term care and outpatient settings. VA Geriatric evaluation services now comprise 34 Inpatient (1 mobile ACE and remainder CLC programs), 64 Outpatient GERI-PACT, 12 over 116 HBPC, 11 and many skilled and non-skilled home and community-based services as result of the Mill Bill.…”

“…Inpatient geriatric units are associated with improved diagnostic accuracy and management of geriatric syndromes, reduced numbers of medications, improved functional outcome, fewer long-term care admissions, and reduced acute care hospital readmissions, improved medication utilization, and establishment of patient-centered goals of care. [2][3][4] A 1993 VA GEM program assessment revealed the average GEM unit then consisted of a mean 12.7 beds (standard unit) to 15.4 beds (non-standard unit) size, with a mean length of stay (LOS) 24.5 days (standard unit) to 69.9 days (non-standard unit). 1 Since that time other geriatric evaluation models have been developed.…”

“…Acute Care for Elders (ACE) Units are specially designed units located in the acute care setting and focused on maintaining function, early discharge planning, and patient-centered ageappropriate care. 2,4 A meta-analysis of ACE programs published in 2012 showed that ACE Units, compared to usual hospital care, had significantly lower length of stays, lower hospital costs, and more discharges home. In addition, the ACE model was associated with fewer falls, less delirium, and less functional decline.…”

Research Priorities in Geriatric Palliative Care: Policy Initiatives

“…Cost reductions have been found related to many outcomes important to policymakers, including decreased hospital costs; decreased hospitalization, emergency department, and intensive care unit rates; reduction in 30-day readmission rates; and decreased hospital mortality. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Most successful models involve some degree of care management. Some are focused on increasing safety and patientcentered care in the inpatient setting, such as Acute Care for the Elderly (ACE) units, the Hospital Elder Life Program (HELP), Nurses Improving Care to Health System Elders (NICHE), and palliative care consult services.…”

“…Some are focused on increasing safety and patientcentered care in the inpatient setting, such as Acute Care for the Elderly (ACE) units, the Hospital Elder Life Program (HELP), Nurses Improving Care to Health System Elders (NICHE), and palliative care consult services. [12][13][14][15][16][17][18][19][20][21][22] Care transitions programs seek to reduce readmissions to the hospital. 23,24 The Hospital at Home program allows some patients with acute illness to entirely avoid a hospitalization.…”