Understanding the Core of Age-Friendly Healthcare
To address the complex needs of older adults, the Age-Friendly Health Systems movement was created by the Institute for Healthcare Improvement (IHI) in partnership with the American Hospital Association and The John A. Hartford Foundation. This initiative focuses on an evidence-based framework, with two central drivers dictating its success: the consistent assessment of the 4Ms and the reliable action taken based on those assessments. These drivers are crucial for moving healthcare beyond a one-size-fits-all approach to one that is individualized and respectful of each older person's unique context.
Driver 1: Reliably Assess the 4Ms with All Older Adults
This first driver emphasizes the importance of comprehensively evaluating four critical areas of an older adult's health and well-being. It moves beyond standard medical examinations to gather a holistic picture of the individual. For age-friendly care to be successful, this assessment must be performed reliably and consistently for every older adult encountered within the health system.
The 4Ms of Age-Friendly Care
- What Matters: This pillar focuses on understanding the older adult's individual health goals and care preferences, which may include end-of-life care wishes. Healthcare providers must actively listen to patients and their family caregivers to ensure care aligns with these personal values. It is a foundation of truly person-centered care, respecting the patient’s autonomy in every decision.
- Medication: This involves using age-friendly medications and practices, which can include reducing or deprescribing high-risk medications that might interfere with mobility, mentation, or the patient's personal priorities. Given that many older adults use multiple prescriptions, regular medication reviews are vital for preventing harmful side effects and interactions.
- Mentation: This area addresses the prevention, identification, treatment, and management of three common conditions in older adults: dementia, depression, and delirium. Regular screening is necessary to catch and manage these conditions across all care settings, ensuring that cognitive and emotional well-being are prioritized.
- Mobility: The goal of this M is to ensure older adults can move safely every day to maintain function and independence. This involves assessing mobility, addressing fall risks through environmental changes and exercise programs, and implementing plans to maximize functional independence.
Driver 2: Reliably Act on the 4Ms
Assessing the 4Ms is only half the equation. The second key driver is putting that information into practice by incorporating the findings into care plans and communication across all settings. This requires a systemic commitment to ensuring that the collected data informs every clinical decision and is visible to the entire care team.
Implementing the “Act On” Driver
- Customized Care Plans: Care plans are tailored based on the patient's values, preferences, and clinical needs identified during the assessment phase.
- Interdisciplinary Communication: All members of the care team—from doctors and nurses to caregivers and pharmacists—must have access to and communicate effectively about the 4Ms documentation.
- System Integration: For large health systems, this means integrating the 4Ms into electronic health records (EHRs) and workflows to ensure consistent application.
- Continuous Improvement: The process is not static. Care teams should regularly reassess and adapt care plans based on changes in the older adult’s condition or preferences.
Age-Friendly Care vs. Traditional Healthcare: A Comparison
| Feature | Traditional Healthcare Approach | Age-Friendly Care Approach |
|---|---|---|
| Focus | Often disease-centric, treating isolated conditions. | Holistic and person-centered, addressing the whole individual. |
| Decision-Making | Provider-directed, with clinicians making most decisions. | Collaborative, with patients and families as active partners. |
| Medication Management | Prescribing based on specific conditions, risking polypharmacy. | Careful review and deprescribing to avoid interfering with patient goals. |
| Mentation | May overlook cognitive and emotional issues like depression or delirium. | Routinely screens for and manages dementia, delirium, and depression. |
| Mobility | Reacts to mobility loss (e.g., after a fall). | Proactive, assessing and maximizing mobility to prevent decline. |
| Goal Alignment | Standardized, assuming uniform patient priorities. | Aligns care with "What Matters Most" to the older adult. |
Addressing Challenges and Looking to the Future
Transitioning to a fully age-friendly system is not without its challenges. These can include addressing ageism within the healthcare culture, overcoming financial barriers, and ensuring adequate training for the workforce in geriatrics. However, organizations like the Institute for Healthcare Improvement are dedicated to advancing age-friendly practices globally, providing resources and training to help systems scale up their efforts and create environments that prioritize the well-being of older adults. The future of age-friendly care is a continuous journey that requires commitment at both the policy and practice level to truly transform eldercare.
Conclusion
Age-friendly care represents a fundamental shift in healthcare, guided by two simple yet powerful drivers: assessing and acting on the 4Ms. By consistently understanding what matters most to older adults, managing their medications effectively, addressing mentation issues, and prioritizing mobility, healthcare providers can deliver more personalized, compassionate, and ultimately more effective care. This approach not only improves health outcomes but also enhances the quality of life for older adults, making their unique needs and values the central focus of their care journey.
