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Des Peres Hospital's ACE Unit Combines Clinical and High-Touch Techniques to Reduce Risk and Effects of Delirium
by Des Peres | Jun 01, 2009

(St. Louis) – A hospital stay has typically been a high-risk proposition for many older seniors.  Urinary tract infections, development of pressure sores, and a loss of ability to handle tasks for daily living are just some of the complications that can arise.

Delirium, a severe, sudden (developing over hours to days), but usually reversible, decline in focus, perception, and mental function is also a risk for older patients.  It can be caused or exacerbated by a variety of issues – including adverse drug reactions, low oxygen levels in the blood, dehydration and urinary tract infection.  Historically, whether onset is before or during hospital stay, patients with delirium have been at higher risk of developing complications during a hospital stay, including a higher risk of dying.

“Delirium has been treated as a predictor of poor outcomes for older patients,” said Joseph Flaherty, M.D., Professor of Internal Medicine, Division of Geriatric Medicine, Saint Louis University School of Medicine.  “In previous studies, patients with delirium, compared to those without, have been shown to have decreased functionality/cognition, an increased Length of Stay (LOS), and even an increased risk of death during a hospital stay.”

But hospitalization doesn’t have to be a scary proposition for older adults.  A recent study of patients on Des Peres Hospital’s Acute Care for the Elderly (ACE) Unit, and specifically those admitted to its Delirium Room, showed that with appropriate management, a delirious patient can recover and possibly even improve their functionality.

“Our study showed that patients with delirium who were treated in the Delirium Room had improved function and were more functionally independent when they leave the hospital, relative to patients with delirium in previous studies who were cared for in a typical hospital setting,” said study administrator Kimberly Steele, PhD.

Des Peres Hospital’s ACE Unit opened in 2003 with the purpose of implementing new techniques in geriatric patient care to minimize the adverse consequences of procedures, tests and medications, and to maintaining patient function levels so that they can return home or to the same level of care as they were before they got sick.

In the ACE unit, older patients are cared for by a multidisciplinary team of nurses, physicians, physical therapists, occupational therapists, pharmacists, case managers, dietitians and pastoral care staff.  Together, they conduct daily medical, behavioral, cognitive and emotional reviews of each patient to help avoid complications and assist the patient in regaining and maintaining good function. 

If patients do develop delirium, they are moved to the Delirium Room – a room with nursing staff present in the room around the clock so they can provide even closer monitoring and care.

“It’s like an intensive care unit for patients with delirium.  I think the reason our study was positive, is because in a Delirium Room care setting, patients with delirium get the treatment they need:  close observation and continuous nursing interaction, while being evaluated and treated for their medical illness,” said Flaherty.

“Elderly patients are fragile,” said Michele Meyer, chief executive officer of Des Peres Hospital.  “Our goal is to treat their acute illness while minimizing their risks for complications – physical and mental.  We are pleased that this study validates the quality of care we provide.”

To be placed on the ACE Unit at Des Peres Hospital, patients have to be 65 or older and have an acute illness.