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Elderly patients benefit from a special kind of health care.

Byline: GUEST VIEWPOINT By Richard Barnhart

The race to implement health care reform can feel like building a rocket while we're launching it. Doctors, hospitals and patients all know we have to change how we deliver care; we're discovering just how hard it is to change to the new while still operating within the constraints of the old.

That's when we look outside ourselves to see what is working. Great examples and models can be found around the country - and right here in the Eugene- Springfield area.

One model is the little known but successful Acute Care for Elders program at Sacred Heart Medical Center's University District hospital. The ACE program uses a team approach to improve care for our country's fastest-growing age group - seniors.

Caring for geriatric patients in a hospital presents challenges that differ substantially from treating younger patients. Older people are more likely to have complex, multisystem medical problems and a higher risk of complications and side effects. They frequently have functional, social and psychological limitations that younger people do not. Even the goal of care can be different. Maximizing the ability to function and the quality of life is often more important than trying to cure a disease.

When elderly people develop acute illnesses that require hospitalization, the risk for undesired complications is especially high. To minimize these risks - and to deal with them appropriately when they occur - some medical centers have championed the concept of hospital wards dedicated to the care of geriatric patients. Often called ACE units, these wards incorporate protocols and staff training to provide state-of-the-art care for acutely ill elderly patients.

Over the past 20 years, clinical studies have compared the outcomes of elderly patients who are admitted to ACE programs with those admitted to general medical units. Last year, the British Medical Journal published a meta-analysis of 22 such studies. It reached the following conclusion:

Patients admitted to ACE-type wards were 25 percent more likely to be alive in their own homes after six months, and 24 percent less likely to be institutionalized or to suffer death or deterioration. An accompanying editorial in the journal stated unequivocally that this type of care should become standard practice.

Under the ACE model, a physician or a geriatric nurse practitioner provides direct patient care. A diverse care team meets daily to discuss each patient's diagnoses and care plan. The team includes a geriatrician, nurses, social workers, a pharmacist, a chaplain, and physical and occupational therapists. The ACE program incorporates protocols and tools not usually available in general medical units, enabling it to provide very high-quality care to frail elderly patients, including those who are confused or agitated.

Not every elderly patient is a good candidate for admission to the ACE program. The best candidates for Sacred Heart's ACE program are elderly people who have an acute illness that requires hospitalization, but who are not expected to require surgery or evaluation by a specialist.

The future of health care is going to require better results for less money. That means providing care differently. The ACE program is an example of the medical community identifying an opportunity to improve care for a subset of geriatric patients, and then investing the expertise and resources necessary to make it a reality.

Richard Barnhart ,M.D., a fellow of the American College of Physicians, specializes in internal medicine and works as a hospitalist at Sacred Heart Medical Center.
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Title Annotation:Guest Viewpoint
Publication:The Register-Guard (Eugene, OR)
Date:Dec 22, 2012
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