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Full Spectrum Inpatient Geriatric Care

ACE Unit supports physical and mental needs of hospitalized older patients

Center for Geriatric Medicine – January 2016

Gowrishankar Gnanasekaran, MD, MPH

Center for Geiatric Medicine and Palliative Care, UH Case Medical Center; Assistant Professor of Medicine, Case Western Reserve University School of Medicine

The Center for Geriatric and Palliative Care Medicine at University Hospitals Case Medical Center is nationally known as a pioneer in programs that improve the health and well-being of older adults in the hospital and at home. 

The UH Case Medical Center Acute Care for the Elderly (ACE) program was the first of its kind in the nation when it was founded in 1994 by Seth Landefeld, MD. Since that time, the model has become a standard of care in many hospitals around the country. The program’s goal at the time was to develop a system of collaboration between disciplines that would allow providers to tailor effective care based on the needs of an individual elderly patient. The hope was that a personal care plan based on comprehensive interdisciplinary assessment might lessen the negative impacts of a hospital stay on an aging patient.

Today, the key to this model remains the interdisciplinary approach, where the team of care providers including a geriatrician, gerontologic clinical nurse specialist, social worker, pharmacist, rehabilitation therapist, dietitian and floor nurses work together to recommend interventions to improve care for frail elders, such as early referrals to therapy services and review of medications to reduce side effects such as confusion or balance. The ACE team conducts rounds on both medical and surgical floors as well as providing geriatric consults for older patients throughout the medical center, and in 2014, opened an eight-bed, physician-led ACE-focused unit.

The ACE unit at UH Case Medical Center also launched a novel program for Prevention of Incident Delirium in the Elderly (PRIDE) in 2014 under the leadership of Gowrishankar Gnanasekaran, MD, MPH, Center for Geriatric Medicine and Palliative Care, UH Case Medical Center; and Assistant Professor of Medicine, Case Western Reserve University School of Medicine.

The concept of PRIDE is simple: to cognitively and physically engage elderly patients, aiming to reduce the risk of delirium and confusion, which can often follow a prolonged hospital stay. Trained volunteers interact one-on-one for up to two hours per week with each patient in activities such as playing cards, looking through photo albums and performing simple mental and physical exercises, mixing a physical activity with a cognitively engaging one. Once patients are discharged, the volunteers follow up with phone calls to assess the benefits of these interventions. The outcomes of the PRIDE intervention will be the subject of a forthcoming study.

“We know that as many as 50 percent of elderly patients may develop delirium during a hospital stay,” says Stefan Gravenstein, MD, MPH, Director of the Center for Geriatrics and Palliative Care at UH Case Medical Center, and Professor of Medicine at Case Western Reserve University School of Medicine. By reducing this risk, the PRIDE program has the potential to shorten lengths of stay and improve outcomes post discharge.

The ACE and PRIDE programs not only aim to lead to a safer hospital stay, but also to develop better plans for a patient’s home care and medical follow-ups.  Together, they comprise a comprehensive care system that the Center for Geriatric Medicine developed to more effectively reach patients in need wherever they are, whether in the hospital, in the community, or in their homes.

To contact Dr. Gnanasekaran directly, email