The goal of this webpage is to provide resources to assist CGS members in advocating for specialized geriatric services to improve seniors' care based on the best available evidence.
To best employ the information collated below, it is recommended that members consider reviewing basic advocacy techniques highlighted in the following article: ADVOCATING FOR IMPROVED HEALTH CARE FOR OLDER CANADIANS: WHAT WE CAN LEARN FROM APPLYING THE MARSHALL GANZ ADVOCACY FRAMEWORK
SPECIALIZED GERIATRIC SERVICES THAT CAN IMPROVE SENIOR'S CARE
Acute Care of the Elderly (ACE) Units
A meta-analysis of ACE units demonstrated results in favor of ACE units for outcomes of falls (RR 0.51), delirium incidence (RR 0.73), length of stay (weighted mean difference -0.61), lower hospital costs (weighted mean difference -$245.80 USD), and fewer discharges to a nursing home (RR 0.82).4,6
This meta-analysis as well as prinicples of ACE Units are described at - Leading Best Practice: Acute Care For Elders Units (ACE) - Evidence and Keys to Successful Operation — CME Journal (geriatricsjournal.ca)
Mobilization Of Vulnerable Elders (MOVE)
Through early assessment of mobility status and mobilization at least 3 times per day in a progressive fashion this intervention decreased length of stay by 3.45 days during the study with the LOS continuing to decrease by 6.1 days after the study .
Ortho-geriatrics refers to co-management by the orthopedic service and in-hospital geriatric services. Several studies have noted cost-saving benefits of the Ortho-geriatric model over the traditional model of admission to orthopedics with as needed consultation to geriatrics/medicine. A systematic review focused on hip fractures demonstrated that the in-hospital Ortho-geriatric model led to statistically significant decreases in time to surgery, length of stay and post-operative mortality.
Hospital Elder Life Program (HELP) to prevent delirium
In a landmark study, length of stay among patients enrolled in the intervention group decreased by 2 days. Interventions resulted in $841,000 cost savings over 9 months.
Geriatric Emergency Management PLUS (GEM PLUS)
The GEM PLUS program is a unique adaptation of the GEM model which was shown to save almost $2 million per year in an Ontario acute care hospital by preventing admissions. These cost saving were accomplished due to three key design features; (1) Regional Governance Structure with a Project Leadership Team of all 20 partners, (2) Accountability Agreements to insure partners delivered promised services, and (3) Purchasing of Urgent Access to Services (72% of GEM money was used to purchase priority access to post-discharge services required to prevent return to hospital).
Geriatric Assessment Units (GAUs): Optimizing Evidence based Inpatient Care in the Modern Hospital
The Geriatric Day Hospital: comprehensive, Multidisciplinary Geriatric Care for Community-Dwelling Older Adults
Leading Best Practices: Emerging Cross-Specialty Collaborative Care Models (Geriatric-Trauma partnership)
Acute Care Dementia Strategies