Acute care for elders components of acute geriatric unit care: systematic descriptive review

OBJECTIVES: To describe the Acute Care for Elders (ACE) model components implemented as part of acute geriatric unit care and explore the association between each ACE component and outcomes of iatrogenic complications, functional decline, length of hospital stay, nursing home discharges, costs, and 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. PARTICIPANTS: Acutely ill or injured adults (N = 6,839) with an average age of 81. 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 = 0.20) averaged across all outcomes, than did early discharge planning (ES = 0.17) or prepared environment (ES = 0.11). 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 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.