Encyclopedia

ACE Model

The Acute Care for the Elderly (ACE) Unit is a model of care specifically designed to address the needs of hospitalized older adults, and to improve clinical outcomes for older patients by preventing functional decline and other complications. The ACE model integrates a physical environment designed to foster functional independence, dedicated staff with expertise in aging, an inter-professional team approach, patient and family-centered care, and discharge planning to the least restrictive environment (Kresevic et al., 1998; Lehman et al., 2006).

An ACE unit includes environmental adaptations for the elderly (for example, flooring to decrease visual glare and noise, enhanced lighting, clocks and calendars in the patient rooms) and some may include a communal living room area for patients to eat meals, socialize, and engage in therapeutic recreation.

ACE Goals

  1. Maintain the patient’s level of pre-admission functioning.
  2. Prevent and/or reduce the following:
    • Falls
    • Skin breakdown
    • Delirium
    • Cognitive decline
    • Functional decline
    • Immobility
    • Constipation
    • Use of Restraints
    • Use of Foley catheters

Links

Note: NICHE Encyclopedia provides links to third-party web sites, however, NICHE & the Hartford Institute for Geriatric Nursing does not recommend and does not endorse any products or any of the content on any third-party websites.

References

  • Allen, K., Weinhardt, J., Liebenauer, L., & Smucker, W. (1998). Applying the Acute Care of Elders (ACE Unit) model of care to stroke patients. Journal of the American Geriatrics Society, 46(9), S32; Poster 62.
  • Allen, K., Weinhardt, J., Liebenauer, L., & Smucker, W. (1998). Utilizing a "prehabilitation" process of care to improve outcomes of patients on a stroke unit. Journal of Stroke & Cerebrovascular Disease, 7(5), 379.
  • Allen, K., Weinhardt, J., Palmer, R., Holder, C., Smucker, W., & Counsell, S. (2000). Stroke unit: another application of the acute care for elders (ACE) Model? Journal of the American Geriatrics Society, 48(8), S72.
  • Amador, L. F., Reed, D., & Lehman, C. A. (2007). The acute care for elders unit: taking the rehabilitation model into the hospital setting. Rehabilitation Nursing, 32(3), 126-132.
  • Asplund, K., Gustafson, Y., Jacobsson, C., Bucht, G., Wahlin, A., Peterson, J., et al. (2000). Geriatric-based versus general wards for older acute medical patient: A randomized comparison of outcomes and use of resources. Journal of the American Geriatric Society, 48, 1381-1388.
  • Barrick, O., Karuza, J., & Levitt, J. (1999). Impacting quality: Assessment of a hospital-based geriatric acute care unit. American Journal of Medical Quality, 14, 133-137.
  • Boltz, M., Capezuti, E., Mezey, M., & Fulmer, T. (2007). Choosing a geriatric nursing model: A guide for NICHE sites. In M. Boltz (Ed.), NICHE Planning and Implementation Guide: A Program for Nurses and Other Staff Working in Acute Care and Affiliated Environments. New York: Hartford Institute for Geriatric Nursing, 16 pages.
  • Clavecilla, L., Stringam, S., Fritsch, T., Liebenauer, L., Holder, C., & Counsell, S. Physician recognition of depressive symptoms in hospitalized medically ill elderly: acute care for elders unit versus usual care. Journal of General Internal Medicine, 13(Supplement 1), 35.
  • Counsell, S. R., Holder, C. M., Liebenauer, L. L., Palmer, R. M., Fortinsky, R. H., Kresevic, D. M., Quinn, L. M., et al. (2000). Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients: a randomized controlled trial of acute care elders (ACE) in a community hospital. Journal of the American Geriatric Society, 48, 1572-1581.
  • Counsell, S., Holder, C., Liebenauer, L., et al. (1998). A randomized trial of an acute care for elders (ACE) unit in a community hospital. Journal of General Internal Medicine, 13(S1), 38.
  • Counsell, S., Holder, C., Liebenauer, L., et al. (1998). The ACE (Acute Care for Elders) manual: meeting the challenge of providing quality and cost-effective hospital care to older adults. Summa Health System.
  • Counsell, S., Holder, C., Liebenauer, L., et al. (1998). A randomized controlled trial of a community hospital ACE unit. Journal of the American Geriatrics Society, 46(9), S13.
  • Counsell, S., Palmer, R., Landefeld, C., et al. (1995). ACE unit implementation in a community hospital. Journal of the American Geriatrics Society, 43(9; Poster 202), SA59.
  • Counsell, S., Palmer, R., Landefeld, C., Holder, C., et al. (1996). A unit for the acute care of the elderly: implementation in a community hospital. Journal of the American Geriatrics Society, 43(9; Poster 202), SA59.
  • Counsell, S., Landefeld, C., Palmer, R., Holder, C., et al. (1996). Impact of an ACE unit on the process of care for elders in a community hospital. Journal of the American Geriatrics Society, 44(9; Abstract 10), S3.
  • Counsell, S., Landefeld, C., Palmer, R., et al. (1997). Impact of an ACE unit on physician and nurse ratings of interdisciplinary care. Journal of the American Geriatrics Society, 45(9), S72.
  • Covinsky, K., King, J., Quinn, L., et al. (1997). Do acute care for elders units increase hospital costs?: a cost analysis using the hospital perspective. Journal of the American Geriatrics Society, 45(6), 729-734.
  • Covinsky, K. E., Palmer, R. M., Counsell, S. R., Pine, Z. M., Walter, L. C., & Chren, M. (2000). Functional status before hospitalization in acutely ill older adults: validity and clinical importance of retrospective reports. Journal of the American Geriatrics Society, 48(2), 164-169.
  • Covinsky, K., Palmer, R., Kresevic, D., et al. (1998). Improving functional outcomes in hospitalized elders: lessons from an acute care for elders unit. Joint Commission Journal on Quality Improvement, 24(2), 63-76.
  • Fosnight, S. M., Allen, K., Holder, C. M., & Hazelett, S. (2004). A strategy to decrease the use of risky drugs in the elderly. Cleveland Clinic Journal of Medicine, 71(7), 561-568.
  • Fulmer, T., Boltz, M., Mezey, M., & Capezuti, E. (2007). The Geriatric Resource Nurse Model: A guide for NICHE sites. In M. Boltz (Ed.), NICHE Planning and Implementation Guide: A Program for Nurses and Other Staff Working in Acute Care and Affiliated Environments. New York: Hartford Institute for Geriatric Nursing, 33 pages.
  • Holder, C., Counsell, S., Liebenauer, L., et al. (1997). Nursing satisfaction with geriatric patient care: ACE unit compared to usual care. The Gerontologist, 37(Special issue 1, Abstract 170), 189.
  • Holder, C., Counsell, S., Liebenauer, L., et al. (1998). Physical restraint use in hospitalized elders: acute care for elders (ACE) unit vs. usual care. Journal of General Internal Medicine, 13(Supplement 1), 35.
  • Holder, C., Counsell, S., Liebenauer, L., et al. (1998). Physical restraint use in hospitalized elders: ACE unit versus usual care. Journal of the American Geriatrics Society, 46(9), S10.
  • Holder, C., Hazelett, S., Robinson, K., Benedict, L., Fulmer, L. A., Claflin, S., Carson, N., & Allen, K. (2004). Outcomes of a guided readmission intervention plan for the elderly: ACE vs. usual care. Journal of the American Geriatric Society, 52(4), P393.
  • Holder, C., Palmer, R., Hazelett, S., et al. (2000). Physical restraint in hospitalized older patients: prevalence, predictors and outcomes. Journal of the American Geriatrics Society, 48(8), S118.
  • Holder, C. M., Ruby, A., Akins, J., Bojanowski, C., Robinson, K., Fulmer, L., Hazelett, S., & Allen, K. (2002). Cost-effectiveness of application of ACE unit model to a care management for a medicare risk population. Abstract Journal of the American Geriatrics Society, 50, 163.
  • Kresevic, D., Counsell, S., Covinsky, K., et al. (1998). A patient-centered model of Acute Care for Elders. In I. Abraham, T. Fulmer, K. Milisen, (Eds.). Nursing Clinics of North America, 33(3), 515-527.
  • Kresevic, D., Counsell, S., Covinsky, K., et al. (1998). Advances in geriatric nursing. In I. Abraham, T. Fulmer, & K. Milisen, (Eds.). Nursing Clinics of North America, 33(3), 515-527.
  • Kresevic, D., & Holder, C. Interdisciplinary care. In R.M. Palmer (Ed.). Clinics in Geriatric Medicine, 14(4), 787-98.
  • Kresevic, D., & Mezey, M. (1997). Assessment of function: critically important to acute care of elders. Geriatric Nursing, 18(5), 216-21.
  • Landefeld, C. S., Palmer, R. M., Kresevic, D. M., Fortinsky, R., & Kowal, J. (1995). 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, 32, 1338-1344.
  • LaReau, R., & Lyons, D. (2007). Developing and expanding the geriatrics nursing knowledge base: A guide for NICHE sites. In M. Boltz (Ed.), NICHE Planning and Implementation Guide: A Program for Nurses and Other Staff Working in Acute Care and Affiliated Environments. New York: Hartford Institute for Geriatric Nursing, 39 pages.
  • Lehman, C., Tyler, S., & Amador, L. F. (2006). Care of the patient with dementia in the acute care setting: the role of an ACE unit. In N. M. Silverstein & K. Maslow (Eds.). Improving hospital care for persons with dementia (pp 167-182). New York: Springer.
  • Liebenauer, L., Counsell, S., Holder, C., Fortinsky, R., et al. (1996). Measuring function at discharge in hospitalized elders: prospective comparison of self-reports and a performance-based measure. Journal of General Internal Medicine, 11(4), 145.
  • Liebenauer, L., Counsell, S., Holder, C., et al. (1998). Validity and usefulness of a performance-based measure of mobility for elders in a hospital intervention. Journal of General Internal Medicine, 46(9), S59; Poster 171.
  • Palmer, R., Counsell, S., & Landefeld, C. (1998). Clinical intervention trials: the ACE unit. Clinical Geriatric Medicine, 14, 831-849.
  • Palmer, R., Landefeld, C. S., Kresevic, D., & Kowal, J. (1994). A medical unit for the acute care of the elderly. Journal of the American Geriatrics Society, 42, 545-552.
  • Panno, J., Kolkaba, K., & Holder, C. (2000). Acute care for elders (ACE): a holistic model for geriatric orthopaedic nursing care. Orthopaedic Nursing, 19(6), 53-60.
  • Robinson, K., Holder, C. M., Bojanowski, C., Fulmer, L., Hazelett, S., & Allen, K. (2002). Care management application of the ACE unit model within an integrated health system. Abstract Journal of the American Geriatrics Society, 50, 86.
  • Wexler, S. (2007). The Acute Care for the Elderly (ACE) Model: A guide for NICHE sites. In M. Boltz (Ed.), NICHE Planning and Implementation Guide: A Program for Nurses and Other Staff Working in Acute Care and Affiliated Environments. New York: Hartford Institute for Geriatric Nursing, 15 pages.