Tailoring care for elderly patients could boost outcomes

Two new studies assess geriatric hospital care programs

Research from Mount Sinai Hospital in New York City and the University of Alabama-Birmingham (UAB) suggests that tailoring hospital care practices for older patients would improve their health outcomes.

The two studies examining geriatric-focused health care programs were published this week in JAMA Internal Medicine.

ACE model focuses on geriatric screenings, specific care

In one study, UAB researchers assessed the Acute Care for Elders (ACE) program, in which a coordinated team of practitioners—including geriatricians, nurses, dieticians, social workers and physical therapists—conducted geriatric screenings and focused on geriatric-specific symptoms.

Specifically, the researchers studied 818 older patients in 25 common diagnosis-related groups who received treatment. They compared outcomes for patients participating in the ACE program and patients receiving usual care from a coordinated team of practitioners.

The researchers found that patients participating in the ACE program cost less and were less likely to be readmitted to the hospital.

Lead study author Kellie Flood told Medpage Today that with a rapidly aging population, it is "vitally important" to identify models that deliver "higher quality care without escalating health care costs." She added that we are seeing "more and more patients with multimorbidity and complex illness, yet we will have fewer and fewer resources to care for those patients."

MACE model coordinates care and shortens hospital stays

In a second study, Mount Sinai researchers assessed the Mobile Acute Care of the Elderly (MACE) model, which involves a team—comprised of a geriatrician-hospitalist, a geriatric medicine fellow, a social worker, and a nurse specialist—who meet daily to discuss care, with the nurse specialist serving as a coach.

Using data on patients treated at Mount Sinai, the researchers compared outcomes for the MACE patients with patients who received care from a usual care team that did not include a nurse specialist or a geriatrician.

The researchers found that the MACE program shortened hospital stays and significantly reduced adverse events. However, the MACE system did not significantly reduce 30-day readmissions.

According to lead author William Hung, "[t]he takeaway message is that reorganization of health care in the hospital to deliver care specialized for older adults is possible and can yield benefits" (Petrochko, Medpage Today, 4/22).

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