Page 40 - Encyclopedia of Nursing Research

ACUTE CARE oF THE ELDERLy n 7

baseline dependencies at admission had devel-
Acute cAre of the elderly oped one or more limitations within 2 months
(Hart, Birkas, Lachmann, & Saunders, 2002). A
individuals older than 65 years are more likely
older people have a greater prevalence of to be admitted to acute care from the emer-
chronic diseases and disorders that lead to gency department than other age groups. The
hospitalization. on average, people older than hospitalized elderly are at an increased risk
65 years are hospitalized more than three for poor outcomes such as increased length
times as often as younger individuals, and of stay, readmissions, functional decline,
the length of their stay is estimated to be and iatrogenic complications, as compared
50% longer than that of younger individuals. with other age groups. There is a significant
Nursing research that defines the evidence for and serious readmission rate for older adults,
practice interventions is needed for patients of ranging from 18% to 33% within 1 to 3 months
all ages, and especially for the elderly (Capezuti and complications such as acute confusion
et al., 2008). Nursing research that provides and nosocomial infections, which are com-
the basis for best practice for hospitalized mon among the elderly, resulting in increased
elders is often embedded in interdi sciplinary morbidity and mortality (Lindenauer et al.,
studies. Several studies have recently docu- 2010). Fifty-eight percent of patients who are
mented the essential nature of continuity of hospitalized will experience at least one iatro-
care across settings for optimal acute care out- genic complication (Hart et al., 2002).
comes (Boyd et al., 2010; Counsell, Callahan, The composition of hospital staff has been
Tu, Stump, & Arling, 2009). increasingly, criti- shown to make a difference in patient out-
cal care of older adults has received attention, comes (Aiken, Clarke, Silber, & Sloane, 2003;
given the demographic shifts nationally and Estabrooks, Midodzi, Cummings, Ricker, &
the advancing age of those in intensive care Giovannetti, 2005; Tourangeau et al., 2007).
units, emergency rooms, and other critical Nurse accountability and models of patients
care areas (Foreman et al., 2010). and nursing administration also have been
Acute care of the elderly (ACE) units, examined (Baggs, 2007; Baggs, Ryan, Phelps,
which developed in the early 1990s, have Richeson, & Johnson, 1992; Piquette, Reeves, &
shown improved outcomes among older Leblanc, 2009; Scherb, Rapp, Johnson, & Maas,
patients who have been hospitalized. These 1998). These studies provide some informa-
units focus on precise and ongoing assess- tion regarding outcomes for the elderly, but
ment of older adults, especially related to intensive effort needs to be focused on under-
functional capacity and decline and follow the standing the differences between outcomes
evidence to create individualized care plans for younger individuals versus older indi-
(Malone et al., 2010). A classic study conducted viduals in the case of hospital care. For exam-
by Landefeld, Palmer, Kresevic, Fortinsky, ple, do older adults have difference cardiac
and Kowal (1995) demonstrated that patients output after coronary artery bypass surgery
admitted to an ACE unit were more likely to than younger individuals when other vari-
improve in activities of daily living and were ables are held constant, such as premorbid
less likely to be institutionalized. Asplund conditions? Such parameters are needed for
et al. (2000) also demonstrated that ACE units the improvement of care for the elderly. The
reduce the institutionalization rate of the hos- Cochrane Collaboration published a review
pitalized elders. The overarching framework on interprofessional education (2009) that
for care on ACE units is interdisciplinary examined the effects on professional practice
teaming (Siegler, Glick, & Lee, 2002). in a pro- and healthcare outcomes and reported that
spective study of 804 patients 80 years of age data from six studies produced positive out-
or older, 42% of the elderly patients with no comes in satisfaction, collaboration, reduction