Cited by 406Frailty in Older AdultsHospital Admissions and OutcomesGeriatric Care and Nursing Homes

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Effects of a Multicomponent Intervention on Functional Outcomes and Process of Care in Hospitalized Older Patients: A Randomized Controlled Trial of Acute Care for Elders (ACE) in a Community Hospital

Counsell, Steven R., Holder, Carolyn M., Liebenauer, Laura L., Palmer, Robert M., Fortinsky, Richard H., Kresevic, Denise M., Quinn, Linda M., Allen, Kyle R., Covinsky, Kenneth E., Landefeld, C. Seth·2000·Journal of the American Geriatrics Society

DOI 10.1111/j.1532-5415.2000.tb03866.x

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Abstract

BACKGROUND: Older persons frequently experience a decline in function following an acute medical illness and hospitalization. OBJECTIVE: To test the hypothesis that a multicomponent intervention, called Acute Care for Elders (ACE), will improve functional outcomes and the process of care in hospitalized older patients. DESIGN: Randomized controlled trial. SETTING: Community teaching hospital. PATIENTS: A total of 1531 community‐dwelling patients, aged 70 or older, admitted for an acute medical illness between November 1994 and May 1997. INTERVENTION: ACE includes a specially designed environment (with, for example, carpeting and uncluttered hallways); patient‐centered care, including nursing care plans for prevention of disability and rehabilitation; planning for patient discharge to home; and review of medical care to prevent iatrogenic illness. MEASUREMENTS: The main outcome was change in the number of independent activities of daily living (ADL) from 2 weeks before admission (baseline) to discharge. Secondary outcomes included resource use, implementation of orders to promote function, and patient and provider satisfaction. RESULTS: Self‐reported measures of function did not differ at discharge between the intervention and usual care groups by intention‐to‐treat analysis. The composite outcome of ADL decline from baseline or nursing home placement was less frequent in the intervention group at discharge (34% vs 40%; P = .027) and during the year following hospitalization (P = .022). There were no significant group differences in hospital length of stay and costs, home healthcare visits, or readmissions. Nursing care plans to promote independent function were more often implemented in the intervention group (79% vs 50%; P = .001), physical therapy consults were obtained more frequently (42% vs 36%; P = .027), and restraints were applied to fewer patients (2% vs 6%; P = .001). Satisfaction with care was higher for the intervention group than the usual care group among patients, caregivers, physicians, and nurses (P < .05). CONCLUSIONS: ACE in a community hospital improved the process of care and patient and provider satisfaction without increasing hospital length of stay or costs. A lower frequency of the composite outcome ADL decline or nursing home placement may indicate potentially beneficial effects on patient outcomes.

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Acute Care for Elders (ACE) Tracker and e‐Geriatrician: Methods to Disseminate ACE Concepts to Hospitals with No Geriatricians on Staff
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BackgroundMethodInfluential

Authors: Counsell, S. R., Holder, C. M., Liebenauer, L. L., Palmer, R. M., Fortinsky, R. H., Kresevic, D. M., Quinn, L. M., Allen, K. R., Covinsky, K. E., & Landefeld, C. S.
Affiliations: Summa Health System (US)
Cleveland Clinic (US)
UConn Health (US)
University Hospitals of Cleveland (US)
Case Western Reserve University (US)
San Francisco VA Medical Center (US)
Corresponding author: Counsell, Steven R.
ORCID: Palmer, Robert M.
Fortinsky, Richard H.
Covinsky, Kenneth E.
Venue: Journal of the American Geriatrics Society
Publisher: Wiley
Published: 2000-12
Volume: 48
Issue: 12
Pages: 1572-1581
ISSN: 0002-8614 (ISSN-L)
1532-5415
DOI: 10.1111/j.1532-5415.2000.tb03866.x
OpenAlex: W2063673978
Cited by: 406
References: 42
Citations by year: 2026: 2 · 2025: 11 · 2024: 8 · 2023: 4 · 2022: 29 · 2021: 33 · 2020: 18 · 2019: 16 · 2018: 16 · 2017: 21 · 2016: 22 · 2015: 18 · 2014: 18 · 2013: 18 · 2012: 29
FWCI: 5.51
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor, 5260 d)
Locations: Journal of the American Geriatrics Society (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute on Aging (AG-10418, P60AG010418)
Topics: Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
Health Sciences › Nursing › Leadership and Management › Hospital Admissions and Outcomes
Health Sciences › Medicine › Geriatrics and Gerontology › Geriatric Care and Nursing Homes
Keywords: acute care for elders, hospitalized older adults, functional decline, activities of daily living, nursing care plan, rehabilitation, nursing home admission, patient-centered care, hospital environment design, restraint, physiotherapy, iatrogenic disease, patient satisfaction, community-dwelling older adults, discharge planning
MeSH terms: Activities of Daily Living, Acute Disease, Aged, Aged, 80 and over, Female, Geriatrics, Health Facility Environment, Hospitals, Community, Hospitals, Teaching, Humans, Male, Ohio, Outcome and Process Assessment, Health Care, Patient Care Planning, Patient Discharge, Program Evaluation, Geriatric Assessment, Hospitals, Private, Patient Satisfaction, Total Quality Management, Patient-Centered Care

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Effects of a Multicomponent Intervention on Functional Outcomes and Process of Care in Hospitalized Older Patients: A Randomized Controlled Trial of Acute Care for Elders (ACE) in a Community Hospital

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