Although the existing geriatric ward could not be redesigned according to the ACE model specifications due to financial constraints, we have dedicated our resources to the training of a multidisciplinary team and to the development of new care procedures.
Training of nurses and GPs
Training of healthcare staff took place twice a month for four months. These one-hour seminars focused on geriatric topics, such as the specificities of the older patient, assessment of disability and recognition of other geriatric syndromes (GS). All the seminars were done under the supervision of the geriatrician of the unit.
Admission criteria were reviewed taking into account human resources and the bed capacity of the unit. Thus, with the approval of the hospital’s management team, it was agreed that any patient aged 65 years and over with at least one geriatric condition (disability, dementia, delirium, falls, etc.) or multimorbidity be admitted, as well as those requiring palliative or end-of-life care. The cut-off age of 65 is a reflection of the median age of older people consulting health facilities in urban areas in Cameroon .
The unit has been equipped with three walkers and two wheelchairs.
Changes in nursing care procedures
At the initiation of this model, two advanced practice nurses and two geriatric nurses were already working according to the patient-centred approach, by assessing patient’s social and physical profile during hospitalization. After the initial training phase, their role was expanded and other elements were included in their routine evaluation of older patients:
- Assessment of functional status with the Katz Index of independence in Activities of Daily Living (ADL) 
- Review of all catheters and tubes
- Collection of information on bowel movements and patient’s diet
- Detection of acute change in mental status
- Prevention of falls during hospitalization
- Promotion of mobility and early ambulation of patients to promote ADL independence
- Therapeutic education for patients and family members
Creation of a multidisciplinary team
Medical rounds led by the geriatrician are done every day at 8.30 am with GPs and nurses. An on-call system is being implemented in the unit to ensure that patients will be provided with the same level of care on weekends and public holidays.
The multidisciplinary team includes a geriatrician, who joined the team in 2018, two GPs, three geriatric nurses and a social worker. A pharmacist and a physiotherapist attend meetings (occasionally for now). The multidisciplinary team rounds take place on Tuesdays at 9.00 am. All patients’ files are reviewed during the round. They are prepared by the nurses the day before the meeting to update all the missing information (such as sociodemographic characteristics or lifestyle). A nurse checks the availability of these documents before the round. A specific form has been developed by our team for this purpose. The round is led by the geriatrician according to the following protocol:
- Presentation of the patient and the reason for admission in the unit (brief summary by a GP)
- Presentation of the following by a nurse: current functional status according to ADL ; pain and comfort status ; ongoing medication
- Review of all geriatric syndromes as assessed by the form
- Inputs by any member of the team
- Identification of patient’s active problems, discussion of complex situations and their possible solutions
- Elaboration of treatment goals for this hospitalization and plans for early discharge
Geriatric mobile team
A geriatric mobile team (GMT) was created to provide geriatric care and comprehensive geriatric assessments as well as to assist with the elaboration of treatment goals for older patients hospitalized in non-geriatric wards. The GMT includes a GP and a nurse, both supervised by the geriatrician.
An outpatient geriatric consultation now provides consultations on Tuesdays and Thursdays at the outpatient unit of the hospital. The geriatrician systematically sees patients discharged from the hospital after two weeks or a month depending on the need. This outpatient consultation is also an opportunity to carry out comprehensive geriatric assessments for patients aged 65 and over, seen routinely or at the request of other colleagues.
During the implementation of the ACE model, 202 patients were hospitalized in the unit, of whom 60.9% (n = 123) were female. The mean age was 79.3 ± 8.8 years, with age ranging from 65 to 109. About 85.9% (n = 171) of our patients had at least one chronic medical condition. The most common comorbidities were hypertension (54.3%, n = 108), joints disorders (25.3%, n = 50), diabetes mellitus (24.1%, n = 48) and cerebrovascular diseases (13.1%, n = 26). At least one geriatric syndrome (GS) was present in about 83.7% (n = 169) of patients. The most prevalent GS were ADL disability in 85.8% of patients (n = 123), urinary incontinence in 55% (n = 105) and delirium in 41.1% (n = 78). Polypharmacy was present in 10% of participants. The mean length of hospitalisation was 7.48 ± 5.14 days with a mortality rate of about 25%.