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Celebrating Ten Years of Improving Health Care for Older Adults
Making Best Geriatric Practice
Standard Practice

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Strategy No. 2: Promoting Work Environment Changes

Supporting the Creation of ACE Units

Acute Care for Elders, or ACE units are inpatient wards providing both standard medical services and advanced geriatric interventions. ACE units are geared toward preventing functional decline in older patients through careful design of the physical environment, collaboration among interdisciplinary teams, and nurse-initiated clinical protocols of care. In ACE units, the hospital environment has a home-like feel and encourages patients to be as active as possible and to be more involved in their care. The use of ACE units has been shown to improve physical function among elderly patients and reduce discharges to long-term care institutions.

ACE units typically have bright lights, flooring that prevents falls, and an activity room for congregate meals, visiting and therapy. The latter is meant to encourage patients to get out of bed and move around, thus reducing the risk for functional decline due to immobility. The staff members on the unit, including nurses, social workers and therapists, have special training in care of older adults, and protocols to promote best geriatric practice, such as not using physical restraints, removing Foley catheters, and early ambulation.

Studies have shown that patient and nursing satisfaction is generally higher in ACE units than on traditional hospital floors.9 In many cases, ACE units produce cost savings. Initial development costs are usually offset by shorter lengths of stay and reduced patient costs. The units have also been shown to make more efficient use of scarce hospital staff, concentrating staff efforts on the patients who need more care.

9- 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." Journal of the American Geriatrics Society. 2000. Vol. 48, Number 12, pp. 1572-1581.

Landefeld CS, Palmer RM, Kresevic DM, 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." New England Journal of Medicine. 1995. Vol. 332, Number 20, pp. 1338-1344.

Palmer RM, Counsell SR, Landefeld SC. "Acute Care for Elders Unit: Practical Considerations for Optimizing Health Outcomes." Disease Management & Health Outcomes. 2003. Vol. 11 , Number 8, pp. 507-517.
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