Acute Care for Elders (ACE) Interdisciplinary Team

One of the key factors involved in the Acute Care for Elders (ACE) philosophy is the collaborative work of the ACE team, which works together to deal with the unique issues faced by older hospitalized adults.
During a typical ACE team meeting, the team assesses each patient by carefully reviewing the patient's condition, problems and progress.
Each contributing his or her own unique professional perspectives, ACE team members collaborate to develop suggestions for the patient's care and follow-up.
The ACE team consists of: 
  • Geriatricians

    These physicians evaluate and diagnose geriatric syndromes, evaluating the patients' mobility, memory, medications, skin integrity, decision-making capacity and risk for falls. They also provide suggestions for management and prevention of the hazards of hospitalization.
  • Advanced Practice Nurse

    This team member performs geriatric assessments and continued daily assessment of hospitalized patients. The advanced practice nurse implements guidelines to prevent functional and cognitive decline of geriatric patients. This role includes educating physicians, nurses and families regarding geriatric topics, including delirium prevention, dementia, sleep and constipation.
  • Social Worker

    This ACE team member assesses the patient's social support network, health insurance coverage and care-giving needs. The social worker reviews and assists with appropriate documentation of advance directives and living wills. This role includes evaluating family dynamics and caregiver issues, as well as arranging referral to community agencies. The social worker acts as an advocate for patients and their families. 
  • Physical Therapist

    The physical therapist evaluates the patient's self-care and functional mobility. The PT members of the ACE team help patients maintain or improve strength, flexibility and endurance of muscles and range of motion of joints. They also recommend assistive devices to help with mobility. 
  • Pharmacist

    ACE pharmacists review patients' medication therapy to achieve an optimal regimen that suits the patient's medical and therapeutic needs from a geriatric perspective. The team pharmacists act as an information resource for the patient and for the patient's health care team.