ACE-ing Seniors’ Hospital Care


Newfoundland and Labrador has the most rapidly aging population in Canada.

What’s more, Newfoundland and Labrador has among the highest rates of multi-morbidity in the country, meaning that many people have more than two chronic diseases.

Like other health-care organizations, Eastern Health is working towards adapting health care to these changing demographics, and preparing for a surge of older and sicker patients.

According to Dr. Susan Mercer, division chief of Geriatric Medicine with Eastern Health, the normal aging process brings inevitable changes in physical, functional and psychosocial health. Although these changes can have negative effects on health and wellbeing – and can worsen health conditions, when it comes to elderly patients, these are often not the focus during an acute (or hospital) care admission.

Dr. Susan Mercer, division chief of Geriatric Medicine with Eastern Health

“Hospitals can be detrimental for seniors; because of their unique care needs, seniors are at higher risk of having adverse events,” says Dr. Mercer.

“Older people are more vulnerable to infections, and when hospitalized, a lack of physical and mental stimulation can speed up their decline, to the point where seniors become deconditioned (loss of strength) and lose their independence. This often results in increased care needs following discharge from hospital, and sometimes can precipitate their move to a nursing home.”

Much of this, however, is preventable with the comprehensive Acute Care of the Elderly approach, also known as ACE, which Eastern Health launched at St. Clare’s Mercy Hospital in St. John’s with much success in January 2017.

The ACE approach

ACE is an evidence-based system of care that has been proven to improve outcomes in hospitalized older adults.

The main goal of ACE is to reduce hospital-associated complications for frail seniors and to promote their return to the community.

The ACE approach involves an assessment by a specialist in seniors’ care, while taking into consideration the challenging needs of this population. ACE is built around five principles: patient-centred care; regular medical review; senior-friendly environment; early rehabilitation and early discharge planning.

Supported by an interdisciplinary team, this model of care provides an effective, proactive and inexpensive framework for addressing the complex health needs of older adults.

Dr. Kim Babb, geriatrician with Eastern Health

Led by Dr. Mercer and Dr. Kim Babb, geriatricians with Eastern Health, nurses and health providers trained in the ACE principles can give special attention to the needs of older patients.

“Elderly clients often present to hospital with a number of inter-related acute and chronic conditions, their medical needs are often more complex and potentially coexist with functional, psychological and social needs,” says Dr. Mercer.

“ACE units offer a comprehensive approach to care and across Canada, they have been shown to help hospitalized older adults maintain functional independence and reduce lengths-of-stay while in hospital, re-admissions to hospital and long-term care placements.”

ACE unit staff (7 West) at St. Clare’s Mercy Hospital. Back row (l-r): Dr. Susan Mercer, division chief of Geriatric Medicine; Sandra Gosse, physiotherapist; Charmaine Lane, division manager; Kimberly Randell, social worker; and Ryan Norman, social worker. Front row (l-r): Tara Bishop, speech language pathologist; Alicia Hogan, nurse practitioner; Sister Betty Morrissey, Pastoral Care; Lisa Heale, occupational therapist; Bev Downey, care facilitator, Debbie Walsh, regional director of Medicine; and Tanya French, dietician

At Eastern Health, the senior-friendly ACE approach uses a number of strategies, such as:

  • involving family participation in care decisions to improve communication and understanding;
  • getting older patients out of bed early to promote recovery through movement;
  • offering more fluids to avoid dehydration;
  • reviewing all medications to reduce medication errors and interactions;
  • lowering beds and using floor mats to decrease falls;
  • using homemade quilts for greater comfort and more friendlier environment;
  • putting delirious seniors in senior-friendly rooms with correct lighting, large clocks and rooms painted in colors that help to decrease confusion; and
  • initiating interventions early to reduce complications.

Remarkable benefits: Greater independence

This new approach at St. Clare’s Mercy Hospital has already led to a number of significant benefits for hospitalized seniors.

Through the ACE approach, staff have seen elderly patients achieve higher levels of independence. In some instances, hospitalized seniors who had been awaiting placement in nursing homes for advance care were eventually discharged back to the community – to either personal care homes or to their own homes with home-care supports in place.

Supporting seniors to maintain their level of independence, which contributes to dignity, self-esteem and fulfilment, is crucial for ensuring happiness and quality of life.

Improved care for elderly patients with dementia

Just as significant, the ACE approach enables better recognition and management of seniors living with dementia while receiving hospital care.

“We’ve had older patients with dementia admitted to hospital who are difficult to provide care because of their state of mental confusion (delirium,) which often results in aggression and agitation,” says Charmaine Lane, division manager with the ACE unit.

The ACE approach has made important strides in this area too. By putting safer mechanisms in place to better manage confusion and delirium, such as the adoption of bed alarms and roam alert systems, the use of physical restraints has decreased.

“I recall a dementia patient who, after being assessed and cared by the ACE unit, cooperated better with his care and was so much happier. These reactions are extraordinary to see,” adds Charmaine.

An ACE rounds session. (l-r) Alicia Hogan, nurse practitioner; Catherine Babstock, physiotherapist; Heather Hollett, social worker; Heather Ash, dietician; Dr. Susan Mercer, division chief of Geriatric Medicine; Lisa Heale, occupational therapist; Charmaine Lane, division manager; Beverly Downey, care facilitator; and Tara Bishop, speech language pathologist

Enhanced communication and seamless transitions

The patient-centred principle of the ACE approach helps to improve communication by sharing knowledge and involving patients and their family in care decisions.

According to Charmaine, families have stated they feel their questions are answered and they know the reasons why certain actions are taken.

Debbie Walsh, regional director of the Medicine Program agrees.“Early intervention, family involvement and frequent communication with patients and families have made for smooth and peaceful transitions through care stages.”

“Further, as the ACE team also follows some patients on discharge, this has allowed for seamless transitions from acute care to community care,” Debbie says.

Future steps

There is no doubt that seniors who are assessed by the ACE team receive top-notch senior-friendly care.

“Families have wept with happiness as they see a loved one work through an episode of delirium, and back to who they always knew,” says Charmaine. “And health providers who are part of the ACE team feel so much better prepared to safely meet the needs of older patients and prevent complications.”

Dr. Mercer insists the major success of the ACE approach has been the organization’s ability to provide an optimal level of comprehensive care to a population that has very unique health-care needs.

“With the ACE approach, we are providing ideal care based on best-practice guidelines. Our older patients and their families are happier with the care they receive, and we have more seniors returning to the community – to their own homes, instead of going to another institutional setting,” says Dr. Mercer.

So, what’s next?

“Our focus now is to work towards expanding the ACE approach across Eastern Health and beyond,” Dr. Mercer adds. “Our population is aging fast, and addressing the unique needs of our seniors to keep them healthy is a requisite for the sustainability of our health-care system. Our ultimate goal is that every frail elderly patient in this province has access to comprehensive geriatric care.”

Quilts donated to help support the senior-friendly environment on the ACE unit (7 West) at St. Clare’s Mercy Hospital. (l-r): Laura Devereaux, physiotherapy support worker; Stephanie Toulouse, RN (registered nurse); Rebecca Simms, RN; Michele Walsh, RN; Marlene Dillon, licensed practical nurse; and Eileen Yard, RN

The ACE approach was initially proposed by Eastern Health’s Seniors Task Force as a patient-centred care strategy for seniors interfacing with acute care services.

The Seniors Task Force, formed in 2016, aims to create senior-friendly care throughout the organization. 

This story was written by Melisa Valverde, digital communications manager, with Dr. Susan Mercer, division chief of Geriatric Medicine and Charmaine Lane, division manager (7 West) of the Medicine Program with Eastern Health.

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