To the Editor Walke and Tinetti1 are spot on in identifying a key challenge for clinicians, researchers, and policy makers interested in improving acute care for older persons. While geriatricians have been adept at developing models of care for older adults, these models serve niche populations in well-designed silos. While “putting the pieces together” is an appealing image, we need to realize that these models combined are reaching only a fraction of frail elderly patients. We commend Flood2 for adapting the Acute Care of the Elderly (ACE) model by complementing the existing care of hospitalists with expertise from geriatricians and Hung et al3 for liberating the ACE concept from the physical unit. There are many different twists on the ACE model. At the University of Colorado Hospital, we place hospitalists with commitment to geriatric care principles on a service that is a hybrid of ACE and MACE (Mobile Acute Care of the Elderly) models.4 Nonetheless, many elderly patients are not touched by these models.
Wald H, Cumbler E. Regarding the Acute Care of the Elderly Model. JAMA Intern Med. 2014;174(10):1709. doi:10.1001/jamainternmed.2013.11119