* Acute care services focused on education and care transitioning improved outcomes among elderly patients.

Acute Care for Elders, or ACE, was a program started in the 1990s to provide targeted, comprehensive care to elderly hospitalized patients. Recognizing that not every facility can support dedicated ACE units, New York's Mount Sinai Hospital developed the Mobile Acute Care of the Elderly (MACE) service to provide inpatient care for patients receiving treatment at the hospital's outpatient geriatrics clinic.

A matched cohort of 173 patients ages 75 years or older received MACE services, provided by a team of geriatricians, a social worker, and a clinical nurse specialist, who met daily. The aim of the MACE team was to educate patients and improve care transitions. The patients were matched to 173 patients admitted to the general medical care unit who received usual care from an internal medicine physician and unit-based social worker.

Although rehospitalization within 30 days, the primary outcome measure, occurred at similar rates in the two groups (after multivariate adjustment), patients in the MACE group had shorter stays (five days versus seven days) than those in the usual care group and lower rates of adverse events (such as falls and pressure ulcers) during hospitalization.

Functional status, including the ability to perform instrumental activities of daily living, was slightly better in the MACE group than in the usual care group. Health status at 30 days was similar between groups.

The authors noted that the MACE approach requires only the additional staffing of the nurse, the cost of which may be balanced by improved patient outcomes, and that the service can be easily integrated into a hospital that doesn't have a dedicated geriatric unit.

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