The Acute Care for Elders Consult Program

Abstract

The Acute Care for Elders (ACE) Consult Program is an evidence-based model focused on improving care of hospitalized elders by targeting comprehensive biopsychosocial and functional needs from hospital admission. The four core principles of ACE include a prepared environment, patient-centered care, multidimensional assessment optimizing medication prescribing, and interdisciplinary team rounds linked with early comprehensive discharge planning. Comprised of a geriatrician and nursing leaders guiding an interdisciplinary team, the originally described “ACE Unit” design has metamorphosed over the past 25 years to meet the unique challenges facing our healthcare system, including responding to financial pressures in an ever-evolving medical environment. Regardless of these configurational changes, the core ACE principles remain: improving outcomes in hospitalized elders by emphasizing patient-centered care, frequent interdisciplinary team rounds designed to manage geriatric syndromes, and early transition planning. Research on ACE Consult Programs demonstrates enhanced care, better prescribing practices, improved physical functioning, less restraint use, increased satisfaction, and reduced length of stay and institutionalization. The future of hospital medicine in America will require ACE programs to continue evolving to address the skyrocketing number of older adults living with multiple chronic illnesses, and do so while facing an increasingly competitive healthcare environment currently dominated by fee-for-service reimbursement schedules that do not necessarily reward providers for working in teams. We propose that ongoing evolution of pay-for-performance strategies will further incentivize the development of pioneering programs built upon ACE principles that will continue to adapt to electronic medical records (EMRs) and the many other technological innovations in geriatric hospital medicine.