Acute Care of the Elderly Column Adapting the Acute Care for Elders (ACE) model to your hospital Mary Fox, RN, PhD School of Nursing, Faculty of Health, York University, Toronto, Ontario, Canada As part of my 2012 e 2013 sabbatical from York University in Toronto, Canada, I traveled to New York University (NYU) to learn about the great work being done in the Nurses Improving Care for Healthsystem Elders (NICHE) program, and to explore future research collaborations with Dr. Marie Boltz and Dr. Elizabeth Capezuti. As a nurse who conducts research on bed rest in Complex Continuing Care (CCC) facilities in Canada, which are similar to Skilled Nursing facilities in the United States (US), I found NICHE hospitals to be an exciting stop on my journey of designing, eval- uating and translating function-focused interventions to improve hospital care and outcomes for older adults. CCC research participants’ experiences of beginning bed rest during an acute illness or injury 1 steered me toward expanding my research to include the acute care setting. During hospitalization for an acute illness or injury, older adults are at risk of leaving hospital functionally worse off than before they entered. 2 In this patient population, hospital-acquired functional decline can increase the prevalence of iatrogenic complications, costs of care, and rates of institutionalization. 2,3 Consequently, preventing func- tional decline during hospitalization is a national priority in both Canada and the US. Having come from the CCC setting, I was unfamiliar with the Acute Care for Elders (ACE) model, but it was recommended that I consider its potential as an exemplar for preventing bed rest in the acute care setting. ACE is a pre-habilitation, function-focused approach to older adults’ hospital care that was designed primarily to prevent functional decline associated with common hospital practices, treatments and environments. 4 With colleagues from Toronto, I undertook a large systematic review and meta- analysis to better understand the overall effectiveness of this approach to hospital care. Our work demonstrated that imple- menting all or parts of the ACE model during the acute phase of an older person’s illness or injury has significant benefits for improving both patient level outcomes e reduced functional decline, iatrogenic complications and nursing home discharges, and increased discharges home e and system level outcomes e reduced cost of care and length of hospital stays, without increasing hospital readmissions. 5 Although the findings provide much needed synthesized evidence supporting overall effective- ness of the ACE model, its widespread acceptance and adoption are hampered by its complexity. ACE is a highly complex intervention that is comprised of five components: (1) patient-centered care to prevent declines in physical, cognitive, and psychosocial functioning; (2) frequent medical review to minimize the adverse effects of treatments on functioning; (3) early rehabilitation to restore functional abilities; (4) early discharge planning to address discharge needs; and (5) prepared environment or modifica- tions to the environment to promote functioning. 6 Complex interventions are seen as difficult to implement 7 and to require substantial effort on the part of the individuals responsible for implementation. 8 In the case of ACE, there is the assumption that all five compo- nents must be implemented on an ACE dedicated unit to achieve beneficial outcomes. My clinical and administrative colleagues explained that the physical and organizational structures of their hospitals make it difficult for them to adopt ACE in its entirety. In particular, the physical infrastructure changes associated with the prepared environment component represent substantial barriers to implementation of ACE. Several nurses, including nurse leaders, who welcomed me into their hospitals during my visit to NYU, shared this sentiment. E-mail address: maryfox@yorku.ca. Elizabeth Capezuti RN, PhD Sarah Hope Kagan RN, PhD Mary Beth Happ RN, PhD Lorraine C. Mion RN, PhD Contents lists available at SciVerse ScienceDirect Geriatric Nursing journal homepage: www.gnjournal.com 0197-4572/$ e see front matter Ó 2013 Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.gerinurse.2013.06.002 Geriatric Nursing 34 (2013) 332e334