Comprehensive geriatric assessment in a hospital: Postacute care units

The concept of postacute care includes an extensive area between acute care hospitals and home care (subacute care, intermediate care, transitional care convalescence). Subacute care units are those, in which patients are admitted, in the immediate postacute periode, closely connected with the acute care in the hospital. Postacute care is needed in patients with advanced age, in which acute fase of the illness has been overcome, the diagnostic process has been finished and functional decline in present. A subgroup of these patients, who are still in the immediate postacute periode, who are minimally medically unstable (fluctuating conditions but not life-threatening) and who still requires basic uncomplicated intermitent treatments, are candidates for a subacute care unit. Postacute care is not a simply hospital acute care extension, but it has to contribute to improve health outcomes in these patients. A comprehensive geriatric assessment may be added to the subacute care requirements. The postacute care environment has ideal conditions to offer an effective geriatric assessment program (stong intervention 24 h a day, more time for intervention than in acute care hospital, patients with recent physical decline). Geriatric assessment in the postacute care setting must be complete, all dimensions must be evaluated with validated instruments and a real and effective interdisciplinary intervention must be performed.