What Are the 4 M's of Geriatrics?
As healthcare for an aging population becomes more complex, the need for a focused, standardized approach has grown. The 4 M's framework—What Matters, Medication, Mentation, and Mobility—was created by the Institute for Healthcare Improvement (IHI) and The John A. Hartford Foundation as part of the Age-Friendly Health Systems initiative. This framework simplifies complex geriatric care by focusing on four core issues that are central to the health and well-being of older adults. This shift from disease-centric to person-centric care ensures that every older adult receives the best care possible, is not harmed by care, and is satisfied with their treatment.
The Four Pillars of Age-Friendly Care
1. What Matters
This is the most important "M," serving as the guiding principle for all care decisions. It involves understanding and acting on the older adult’s personal health goals, care preferences, and priorities. This goes beyond just medical issues to include personal values, hobbies, and activities they want to continue doing. For example, an older adult may prioritize being able to walk in their garden over a specific blood pressure target. This requires an open and ongoing conversation with the patient and their family to ensure their wishes are understood and respected throughout the care process.
2. Medication
Older adults often take multiple medications, a condition known as polypharmacy, which increases the risk of harmful side effects and drug interactions. This "M" focuses on using age-friendly medications that do not interfere with what matters to the patient or impact their mentation and mobility. It involves a critical review of all medications, including over-the-counter drugs, supplements, and prescriptions, to ensure they are necessary and appropriate for the individual. The goal is to eliminate any potentially harmful medications and simplify regimens where possible, improving quality of life and safety.
3. Mentation (Mind)
This pillar addresses the crucial aspects of cognitive and emotional health. It requires identifying and managing conditions like depression, delirium, and dementia across all care settings. Screening for these issues becomes a standard part of care, ensuring early detection and appropriate management. Delirium, in particular, can be a serious and sudden change in mental state, often missed in older adults. By intentionally screening for mentation changes, healthcare providers can intervene early to prevent further decline and ensure mental clarity is maintained as much as possible.
4. Mobility
Mobility is fundamental to maintaining independence and performing daily activities. This "M" ensures that older adults in every care setting are encouraged to move safely every day. The focus is on preventing falls, promoting physical function, and preserving strength. This can involve personalized exercises, physical therapy, and modifying the environment to reduce fall risks. Promoting daily movement, even in small ways, helps older adults remain active and engaged with their personal goals, tying directly back to the "What Matters" M.
How the 4 M's Framework Is Put into Practice
Implementing the 4 M's of geriatrics is a systematic process that shifts a healthcare system’s culture toward an age-friendly model. It is not a rigid program but a flexible framework integrated into existing workflows. Here is a numbered list of common implementation steps:
- Assess the current state: Healthcare teams review their current practices to identify how they align with the 4 M's and where improvements can be made.
- Define and design care: Workflows and care plans are redesigned to consistently incorporate all four M's into every patient interaction.
- Provide care: Teams begin providing care based on the new 4 M's-aligned protocols, often starting with a small group of patients before expanding.
- Measure and study performance: Providers measure the impact of the changes by tracking outcomes, patient satisfaction, and other key metrics.
- Improve and sustain: The process is continuously refined based on feedback and data, ensuring the 4 M's become a sustainable part of the care delivery model.
Comparing Traditional vs. 4 M's Geriatric Care
| Feature | Traditional Geriatric Care | Age-Friendly 4 M's Framework |
|---|---|---|
| Focus | Primarily on disease treatment and organ systems. | Centered on the older adult's individual priorities and wellness. |
| Medications | Adding new prescriptions for every symptom. | Deprescribing unnecessary medications and using age-friendly options. |
| Cognitive Health | Addressing issues only when they become severe problems. | Proactively screening for and managing dementia, delirium, and depression. |
| Mobility | Often a secondary concern, sometimes inadvertently hindered. | A primary focus, with daily, safe movement integrated into care plans. |
| Communication | Can be siloed between specialists, fragmented care. | Integrated and organized, with a clear focus on the patient's holistic needs. |
Benefits of Integrating the 4 M's
Integrating the 4 M's into healthcare offers profound benefits for both older adults and the healthcare system. By making care more organized and person-focused, the framework leads to several positive outcomes:
- Improved patient outcomes: A holistic approach reduces the risk of harm from medications and helps maintain cognitive and physical function.
- Enhanced patient and family satisfaction: When care aligns with the patient's priorities, satisfaction and engagement increase.
- Streamlined communication: The framework provides a common language for all members of the care team, from nurses to specialists, to ensure consistent and coherent care.
- Increased efficiency: Focusing on the most critical issues helps prioritize resources and reduces costs associated with preventable complications.
- Better quality of life: Ultimately, the 4 M's help older adults maintain their independence and live with a higher quality of life, focusing on their strengths rather than just their diseases.
Conclusion
Implementing the 4 M's of geriatrics represents a crucial paradigm shift toward truly person-centered care for older adults. By simplifying the complexities of geriatric health into four core, manageable areas—What Matters, Medication, Mentation, and Mobility—healthcare providers can ensure that older adults receive effective, safe, and dignified care. This framework empowers patients and their families, streamlines communication among care teams, and ultimately leads to better health outcomes and a higher quality of life. Embracing the 4 M's is not just a clinical best practice; it is a commitment to respecting the individuality and inherent worth of every older person. For more in-depth resources, you can visit the Institute for Healthcare Improvement on Age-Friendly Health Systems.
