More than 150,000 Americans 65 years and older will have major gastrointestinal surgery annually, and these patients frequently experience functional and cognitive decline, leading to reduced quality of life and diminished survival. Clinical outcomes in older patients are significantly improved when hospitals utilize an Acute Care for Elders (ACE) treatment model in which older patients are placed in specialized units where a multidisciplinary team follows evidence-based geriatric care practices. Due to a shortage of geriatric-trained physicians, dissemination of the ACE model for surgical patients has been limited, and most hospitals lack the financial resources to create dedicated ACE units. Geriatricians and surgeons at UAB have implemented a modified version of the ACE model (Virtual ACE) to address these problems with dissemination of the ACE model. Virtual ACE is a novel combination of information technology and engagement with nursing staff to deliver ACE quality care without requiring specialized geriatric units.
Enhancing use of geriatric care principles is especially important for gastrointestinal surgery patients, because surgery causes multiple functional deficits and surgeons frequently fail to adjust post-operative care to the unique needs of older patients. Currently, Virtual ACE has been implemented on four surgical units at UAB, and our preliminary work suggests that Virtual ACE improves some short-term postoperative outcomes. This project will enhance the dissemination and implementation of evidence-based geriatric care for surgical patients.