The Growing Need for an Age-Friendly Approach
As the population ages, healthcare systems face increasing pressure to provide care that is not only effective but also tailored to the unique needs of older adults [1.4.7]. Many seniors live with multiple chronic conditions and take numerous medications, making their care complex [1.4.2]. The Geriatric 5Ms framework was developed to simplify and standardize the key areas of focus in geriatric care, ensuring that healthcare professionals can deliver high-quality, reliable, and patient-centered services [1.2.1, 1.6.4]. This model moves beyond treating individual diseases and instead concentrates on the whole person, their goals, and their overall quality of life [1.5.3].
1. What Matters
This is the cornerstone of the 5 M's framework. It involves actively listening to and understanding each older adult's health outcome goals, care preferences, and what is most important to them in their daily life [1.2.2, 1.3.2].
- Goal Alignment: Care plans should be aligned with the patient's individual values and priorities, not just clinical metrics [1.6.6].
- Advance Care Planning: This includes discussions about end-of-life care, living wills, and appointing a healthcare proxy [1.3.4].
- Shared Decision-Making: Clinicians work collaboratively with patients and their families to make health decisions that respect the patient's wishes [1.2.2].
2. Medication
Older adults are at a higher risk for adverse drug events due to polypharmacy (taking multiple medications) and age-related changes in how the body processes drugs [1.2.6].
- Deprescribing: A key focus is on identifying and discontinuing medications that are no longer necessary or may be causing harm [1.2.8].
- Medication Reconciliation: This involves creating the most accurate list possible of all medications a patient is taking to avoid errors [1.2.2].
- Age-Friendly Prescribing: When medication is necessary, providers should choose drugs that have a favorable risk-benefit profile in older adults and are less likely to impact mobility or mentation [1.5.3].
3. Mentation (Mind)
This 'M' focuses on maintaining cognitive function and addressing mood disorders [1.2.7]. It covers the spectrum of cognitive and mental health, including dementia, delirium, and depression [1.3.2].
- Cognitive Screening: Regular screening for cognitive impairment helps in early detection and management [1.3.5].
- Delirium Prevention: Identifying patients at risk for delirium (a sudden change in mental function) and implementing preventive measures is critical, especially during hospitalization [1.3.4].
- Depression and Anxiety: Screening for and managing mood disorders is essential for improving an older adult's quality of life [1.2.7].
4. Mobility
Maintaining mobility is crucial for an older adult's independence and overall health [1.3.1]. This 'M' focuses on ensuring that older adults can move safely every day to maintain function and do what matters to them [1.6.2].
- Fall Prevention: Assessing fall risk through tests like the 'Timed Up and Go' and implementing strategies to prevent falls are key components [1.2.2].
- Functional Assessment: Evaluating a patient's ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs) helps create targeted interventions [1.3.5].
- Promoting Safe Movement: Encouraging physical activity and referring to physical or occupational therapy can help maintain strength and balance [1.2.2].
5. Multicomplexity
Multicomplexity acknowledges that older adults often live with multiple chronic conditions, complex social situations, and functional limitations that impact their health [1.2.1, 1.2.2]. This 'M' addresses the interplay between these various factors.
- Holistic Assessment: It involves looking beyond individual diseases to understand how they interact and affect the patient's life [1.3.4].
- Care Coordination: Managing multiple conditions often requires a team-based approach, involving specialists, primary care providers, social workers, and caregivers [1.4.6].
- Prioritizing Treatments: When multiple conditions are present, it's important to prioritize treatments based on the patient's goals and prognosis, recognizing that guidelines for single diseases may not apply [1.2.2].
Comparing the 5 M's
| M Category | Primary Focus | Key Actions |
|---|---|---|
| What Matters | Patient's goals, values, and care preferences | Align care with patient priorities, advance care planning. |
| Medication | Safe and effective use of medications | Deprescribing, medication reconciliation, age-friendly prescribing. |
| Mentation | Cognitive and mental health | Screen for dementia, delirium, and depression; manage agitation. |
| Mobility | Safe movement and functional independence | Assess fall risk, screen function, encourage physical activity. |
| Multicomplexity | Management of co-existing conditions and factors | Holistic assessment, care coordination, prioritize treatments. |
Implementing the 5 M's in Practice
Successfully implementing the 5 M's requires a systematic approach and commitment from the entire healthcare team [1.5.6].
- Leadership Buy-In: Health system leaders must prioritize and support the adoption of the age-friendly framework [1.5.6].
- Team Education: All staff, from physicians to medical assistants, should be educated on the 5 M's and their roles in implementing them [1.5.6].
- Integrate into Workflow: Incorporate assessments for each 'M' into existing clinical workflows rather than adding them as separate tasks [1.6.1]. For example, mobility can be assessed while walking a patient to the exam room.
- Utilize Technology: Leverage electronic health records (EHRs) to create reminders, order sets, and documentation templates that support 5 M's care [1.5.6].
- Engage Patients and Families: Provide patients and their caregivers with information about age-friendly care so they can be active partners in the process.
Conclusion
The 5 M's of age-friendly health care provide a simple yet powerful framework to improve the health and well-being of older adults. By consistently focusing on What Matters, Medication, Mentation, Mobility, and Multicomplexity, healthcare systems can deliver care that is safer, more effective, and better aligned with the personal goals of every older adult. For more detailed guidance, the Institute for Healthcare Improvement (IHI) offers extensive resources on becoming an Age-Friendly Health System.
