The 4Ms provide a foundational approach to health and well-being for older adults, moving care beyond simply treating disease to focusing on a person's overall quality of life. By integrating the 4Ms into existing healthcare practices, providers can deliver more efficient and effective care. This person-centered model ensures that care plans are aligned with the patient's individual goals, preferences, and well-being, promoting better health outcomes and a more positive care experience.
The Four Elements of Age-Friendly Care: The 4Ms
The 4Ms are a set of four evidence-based elements that form the basis of Age-Friendly Health Systems. They guide healthcare professionals in providing high-quality care that is focused on the specific needs of older adults.
1. What Matters
This element focuses on aligning an older adult's care with their personal goals and preferences. A person's goals might include maintaining independence, spending time with family, or pursuing a favorite hobby. For care to be truly person-centered, healthcare teams must have conversations with patients and their families to understand these priorities. This element ensures that medical decisions are not made in a vacuum but are integrated into the context of the patient's life.
- Eliciting patient priorities: Healthcare providers actively ask older adults about their goals, values, and preferences for their health and life. This includes discussing things like functional independence, social connection, and end-of-life wishes.
- Tailoring care plans: The care plan is adapted to reflect what is most important to the patient. For example, if a patient prioritizes maintaining mobility to stay active, their care plan will emphasize mobility support and minimizing medications that might impair balance.
- Documentation and communication: Patient goals are clearly documented and communicated across all members of the care team to ensure everyone is working toward the same purpose.
2. Medication
This element addresses the unique complexities of medication management in older adults. The aim is to use medications only when necessary, avoiding those that are high-risk, and ensuring that all prescriptions support rather than compromise the patient's overall health and independence. Polypharmacy (the use of multiple medications) is a common issue that can lead to adverse drug events, falls, and cognitive impairment.
- High-risk medication review: Healthcare providers regularly review all medications, including over-the-counter drugs, to identify and avoid potentially harmful medications for older adults, often referencing guidelines like the Beers Criteria.
- Deprescribing: When safe and appropriate, providers reduce or discontinue medications that may no longer be necessary or whose risks outweigh their benefits.
- Minimizing drug interactions: The care team monitors for drug-drug interactions that could negatively impact the other 4Ms—Mobility, Mentation, and What Matters.
3. Mentation (Mind and Mood)
Mentation focuses on preventing, identifying, and managing issues related to cognitive function, such as dementia, delirium, and depression. These conditions are common in older adults and can significantly impact their well-being, functional abilities, and satisfaction with care. Routine screening and management are essential components of age-friendly care.
- Screening for cognitive impairment: Healthcare teams regularly screen for cognitive changes using validated tools to detect issues early and refer for further evaluation if needed.
- Addressing mood disorders: Providers screen for and manage depression, which is often under-diagnosed in older adults, recognizing its link to cognitive and physical health.
- Preventing and managing delirium: Special attention is given to preventing and rapidly managing delirium, a state of acute confusion that is especially dangerous for older adults in hospital settings.
4. Mobility
This element is about ensuring that older adults can move safely every day to maintain their function and independence. Maintaining mobility is critical for older adults to do the things that matter most to them. A focus on safe mobility helps prevent falls, a leading cause of injury among the elderly.
- Routine mobility assessment: Healthcare teams routinely assess the patient's mobility, balance, and gait using simple screening tools.
- Establishing daily mobility goals: Patients are encouraged to set and track daily mobility goals, and the care team supports them in achieving these goals.
- Managing mobility impairments: Pain, fear of falling, or other impairments that limit mobility are assessed and managed, often involving referrals to physical or occupational therapy.
Implementing the 4Ms: A System-Wide Commitment
Implementing the 4Ms requires a commitment from the entire healthcare system, not just individual providers. From leadership to frontline staff, everyone plays a role in creating an age-friendly environment. Key steps for implementation include:
- Assess the Current State: Evaluate how the 4Ms are currently addressed across different departments to identify gaps.
- Define Consistent 4Ms Care: Develop clear, standardized procedures for how the 4Ms will be addressed for all older adults.
- Design Workflows: Adapt existing workflows to reliably incorporate the 4Ms into every patient encounter.
- Provide and Refine Care: Start with small-scale tests and use tools like Plan-Do-Study-Act (PDSA) cycles to refine and scale up the process.
Comparison of Age-Friendly Care Elements
| Element | Focus | Key Actions | Patient Benefit |
|---|---|---|---|
| What Matters | Individual's goals and preferences | Elicit and document patient priorities, align care plans with goals. | Increased patient satisfaction, holistic care, and goal achievement. |
| Medication | Safe and effective medication use | Review for high-risk medications, deprescribe when possible, minimize polypharmacy. | Reduced risk of adverse drug events, falls, and improved function. |
| Mentation | Cognitive and mental health | Screen for dementia, delirium, and depression; manage related symptoms. | Improved mood, cognitive function, and reduced delirium episodes. |
| Mobility | Safe, daily physical movement | Assess gait and balance, establish daily mobility goals, manage impairments. | Maintained independence, reduced fall risk, and improved function. |
Conclusion
The 4Ms framework provides a comprehensive, evidence-based approach to answering the question, "What are the 4 elements of age friendly care?". By centering care on What Matters, managing Medication safely, addressing Mentation concerns proactively, and promoting Mobility, healthcare systems can dramatically improve the health outcomes and well-being of older adults. This shift from a disease-focused model to a person-centered model not only benefits patients but can also increase efficiency and reduce costs for health systems. As the population continues to age, widespread adoption of the 4Ms will be crucial for delivering high-quality, dignified care that truly respects what matters most to each individual.
An excellent resource for health systems and providers looking to learn more about the 4Ms framework is the Institute for Healthcare Improvement's Age-Friendly Health Systems initiative.
