Acute Care for the Elderly Unit (ACE)
Hospitalized elders often have multiple and complex medical issues, requiring comprehensive assessment and close attention by a well coordinated treatment team. Furthermore, hospitalization for the frail elderly can pose a significant risk for a decline in general function. The Acute Care for the Eldery (ACE) Unit at Maine Medical Center is specifically designed to address these needs and to prevent functional decline in acutely ill, hospitalized, community dwelling elders and assist them and their families with the transition back into the community. This multidisciplinary model of care has been shown nationally to significantly improve the clinical outcomes of hospitalized elderly patients, improve their functional status at discharge and reduce the rates of transfer to nursing homes. The program's success lies in its attention to maintaining physical and psychosocial functioning despite an acute illness and in its provision of education and support to patients and their families around medications, geriatric syndromes, living options and community resources. The philosophy is further complimented by an environmental design and that encourages mobility and prevents physical injury. There is a focus on getting patients out of bed and moving around as early in the hospital stay as well as attention to delirium prevention.
Patients over the age of 70 on the ACE Unit at Maine Medical Center are evaluated for risk factors that can result in functional decline. These risk factors include: evidence of geriatric syndromes, such as hearing or vision impairment; impaired mobility; altered urinary or bowel elimination; cognitive dysfunction as evidenced by presence of depression, delirium and/or dementia; dehydration/malnutrition; impairment of self care; living alone or with poor social supports; hospitalization within last 31 days; or evidence of neglect or abuse. The specifics of the individual cases are reviewed in a daily interdisciplinary team meeting.
The ACE Unit team at Maine Medical Center includes a:
- Advance Practice Geriatric Clinical Nurse Specialist
- Physical or Occupational Therapist
- Social Worker
- Chaplain representative
- Care Coordinator
- Nurse Manager
- Nurse Director
- Charge Nurse
- Geriatric Psychiatric Nurse Practitioner
This team meets daily to review risk factors for decline and make recommendations to minimize or modify these factors. The team begins discharge planning from admission, attempting to identify a reasonable discharge date and location that takes into consideration the medical and social considerations of the individual patient. Individual team members will meet with patients related to specific issue raised by the team or expressed by the patient or their family. In addition, nursing care protocols are initiated to target risk factors.
Common diagnosis in patients on the ACE units are likely to be congestive heart failure, dehydration, mental status change, gastrointestinal bleeding, pneumonia, stroke, or chronic obstructive pulmonary disease.