Models of Care

The science of health care targeting the unique needs of older adults has evolved tremendously during the last 30 years including the development of several geriatric models of care across all health care settings. This chapter describes the most prominent geriatric hospital models of care, including their objectives, unique strategies, and outcomes. All geriatric care models aim to prevent complications and address hospital factors that can contribute to complications. Although each may differ in their approach, all incorporate the principles of comprehensive geriatric assessment: physical health, functional status, psychological health, and socio-environmental parameters. The overall objectives of the models are similar: educate health care providers in core geriatric principles, target risk factors for complications, incorporate patient or family choices and treatment goals, employ evidence-based interventions, promote interdisciplinary communication, and emphasize proactive discharge planning (or transitional care). Geriatric models of care usually include institutional approaches that address workforce issues as well as how the evidence-based geriatric care processes are embedded within the organizational structure of the hospital or health system. Specific models of care described include the consultative service or mobile ACE unit, NICHE, and HELP as well as evolving surgical specialty models of care.