The Four Pillars of Age-Friendly Care: The 4Ms Framework
An age-friendly health system is built upon the 4Ms Framework, a set of four evidence-based practices designed to address the specific needs of older adults. Implementing the 4Ms reliably and consistently for all older adults in all care settings is fundamental to becoming an age-friendly health system.
What Matters: Centering Care on Patient Goals
This principle emphasizes aligning care with the older adult's health goals and care preferences, including end-of-life considerations. It involves actively understanding and documenting what is most important to the patient and their family.
Medication: Optimizing Drug Therapy
Focuses on using age-friendly medications and reducing those that are high-risk. The goal is to ensure medication does not interfere with the older adult's mobility, mentation, or what matters most to them. This includes regular review and deprescribing when appropriate.
Mentation: Addressing Mind and Mood
This M addresses cognitive function, including dementia, depression, and delirium. An age-friendly system implements practices for prevention, identification, treatment, and management of these conditions.
Mobility: Promoting Safe Movement
Ensures that older adults move safely every day to maintain function and independence. This involves assessment of mobility, creating a safe environment, and implementing protocols to encourage movement.
The Implementation Journey
Becoming an age-friendly health system requires a commitment to reliably implementing the 4Ms across all care settings. This involves assessing current practices, adapting workflows, and providing education to all staff members. The Institute for Healthcare Improvement (IHI) and its partners guide this transformation.
Comparison: Traditional vs. Age-Friendly Care
| Feature | Traditional Care Approach | Age-Friendly Care Approach |
|---|---|---|
| Focus | Often disease-centric; focuses on treating specific conditions in isolation. | Person-centric; focuses on the older adult as a whole, including their goals and preferences. |
| Patient Involvement | Can be passive; patient is a recipient of care. | Active partnership; patient and family are central to decision-making. |
| Medication Management | Prescribing based on specific conditions, with less emphasis on holistic impact. | Comprehensive review to reduce polypharmacy and ensure medications don't interfere with function. |
| Cognitive Health | Often overlooked or addressed only when problems become severe. | Proactive screening and management of dementia, depression, and delirium. |
| Mobility | May be limited due to hospital protocols or lack of emphasis. | Encouraged and supported with safe, evidence-based practices to maintain independence. |
| Outcome Metrics | Focus on disease-specific metrics and readmission rates. | Includes patient satisfaction, functional status, and overall quality of life. |
Sustaining Age-Friendly Care
Sustaining age-friendly care requires a systemic approach that embeds the 4Ms into the culture and operational processes of the health system. This ensures reliable delivery of person-centered care for older adults over the long term.
More information on the official initiative and resources for implementation can be found on the Institute for Healthcare Improvement website.
Conclusion: Elevating Care for Older Adults
Meeting the requirements for an age friendly health system means consistently applying the 4Ms framework—What Matters, Medication, Mentation, and Mobility—to provide high-quality, person-centered care for older adults. This shift improves patient outcomes, enhances satisfaction, and prepares health systems for the growing needs of the aging population.
