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A New Model for Older Patients

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A Delaware system's specialty unit for the elderly improves care quality and centralizes resources.

Hospitals often struggle with the conundrum of elderly care. How can providers treat an influx of older patients while facing a shortage of staff trained in geriatric care? Treating the elderly is often a challenge even without baby boomers and inadequate staffing; senior-age patients are more susceptible to risks like falls and pressure ulcers, and they must be monitored more closely than many other patients.

Typically, elderly patients are interspersed throughout acute-care units with patients of all ages. But some hospitals are grouping seniors in units devoted to elderly care, helping to centralize resources and improve patient care.

In 2005, Christiana Hospital in Newark, DE, part of the Wilmington-based Christiana Care Health System, opened its acute care for the elderly (ACE) unit devoted to caring for patients 70 years old and up. Last year, that 31-bed unit expanded to 41 beds, and a second 11-bed unit opened at Christiana Care's Wilmington Hospital.

"Patients were coming to us increasingly from nursing homes—older, more frail, and therefore more vulnerable. We were looking for a way to better serve the needs of that specific population," says Janice E. Nevin, MD, vice president of medical affairs, Christiana-Wilmington, and chair of the system's department of family.

The ACE unit was designed to improve outcomes in senior-age patients by reducing treatments or factors that can affect an elderly patient's recovery. Older patients are at a higher risk for falls, skin breakdowns, and constipation, and treatments commonly used in other acute-care units, like sleep medication or Foley catheters, present a risk to patients who are already weak, Nevin says.

Although each unit is overseen by a geriatrician, physicians throughout the hospital can admit to the ACE unit and then work with the geriatrician to create a care plan. ACE nurses receive eight hours to 16 hours of training specific to the care of elderly patients.

"Cohorting" patients is not a new concept in healthcare, but patients are typically grouped by condition. What makes Christiana's concept different, Nevin says, is that it was created "around a population of patients who have a variety of diagnoses, but they all share age as a common factor."

—Molly Rowe

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