Understanding the Age-Friendly Hospital Initiative
For many years, older adults have faced unique challenges within the hospital setting, from adverse drug reactions to heightened risk of delirium and falls. In response, organizations like the Centers for Medicare & Medicaid Services (CMS), the Institute for Healthcare Improvement (IHI), and The John A. Hartford Foundation partnered to drive a change in how hospitals approach geriatric care. This collaboration led to the development of the Age-Friendly Hospital Measure, a programmatic measure that publicly reports on hospitals' dedication to age-friendly practices.
Beginning in 2025, hospitals participating in the Hospital Inpatient Quality Reporting (IQR) program must report on their compliance with this new measure. This is a significant step towards ensuring that healthcare for the senior population is not just reactive but proactive, focusing on preventing complications and aligning care with what older adults value most. Hospitals that fail to report risk facing significant financial penalties, which underscores the seriousness of this initiative.
The Core Framework: The 4Ms
The foundation of the Age-Friendly Health Systems initiative is a set of four evidence-based practices known as the “4Ms.” These principles provide a clear, practical guide for medical professionals to reliably deliver the highest quality care to older adults, particularly during hospital stays. The 4Ms are:
- What Matters: This involves understanding and aligning care with each older adult’s specific health outcome goals and care preferences. It moves beyond just treating a medical condition to considering the patient’s holistic well-being and what they want to achieve from their care journey.
- Medication: This component focuses on using age-friendly medications that do not interfere with an older adult's mobility, mentation, or what matters most to them. It emphasizes optimizing medication management by reviewing pharmacological records to avoid potentially inappropriate medications (PIMs).
- Mentation: This is about preventing, identifying, treating, and managing dementia, depression, and delirium across all care settings. It includes screening for cognitive impairment using validated instruments to enable early detection and intervention.
- Mobility: The goal here is to ensure that older adults move safely every day to maintain function and do what matters to them. This can involve early mobility programs and personalized movement plans during their hospital stay.
The Five Domains of the Age-Friendly Hospital Measure
The programmatic measure officially adopted by CMS is structured into five key domains. Hospitals must attest that they are meeting all components within a domain to receive a point, with no partial credit awarded. A hospital's total score, from zero to five, is then displayed on Care Compare, allowing the public to assess their commitment to age-friendly care. The five domains are:
- Eliciting Patient Healthcare Goals: Hospitals must implement protocols to obtain, review, and document patient healthcare goals and preferences. This includes advance care planning, living wills, and identifying healthcare proxies, ensuring care aligns with the patient's wishes.
- Responsible Medication Management: This domain requires hospitals to use evidence-based guidelines to review medications for potentially inappropriate medications (PIMs) for older adults upon admission and before procedures. Any necessary adjustments or discontinuations must be documented.
- Frailty Screening and Intervention: Hospitals must screen patients for frailty-related risks, including cognitive impairment (delirium), mobility, and malnutrition, using validated instruments. Positive screens must lead to the creation of management plans to address identified risks.
- Social Vulnerability: This domain focuses on screening older adults for social vulnerabilities, such as isolation, economic insecurity, caregiver stress, and limited healthcare access. Hospitals must develop intervention strategies and provide referrals for patients who screen positive.
- Age-Friendly Care Leadership: A point person or interprofessional committee must be designated to prioritize age-friendly care issues. This leadership is responsible for overseeing initiatives, providing staff education, and using quality data to drive continuous improvement.
Comparing Traditional vs. Age-Friendly Hospital Care
The move towards age-friendly care represents a fundamental shift in philosophy, focusing on proactive, patient-centered strategies rather than reactive treatment. The following table highlights some key differences:
| Feature | Traditional Hospital Care | Age-Friendly Hospital Care |
|---|---|---|
| Focus | Primarily on treating acute medical conditions or injuries. | Holistic, patient-centered care aligned with individual goals and preferences. |
| Medication Management | Less emphasis on adjusting medication based on age-specific risks; potential for polypharmacy. | Uses evidence-based guidelines to review medications, minimizing high-risk and unnecessary drugs for older adults. |
| Mentation & Cognition | Potential for missed or undertreated delirium, dementia, and depression. | Uses validated screening tools to systematically prevent, identify, and manage mentation issues. |
| Mobility | Risk of immobility and functional decline during hospital stay. | Promotes safe, daily mobility to maintain function and prevent hospital-associated deconditioning. |
| Vulnerability | Social factors often overlooked or not systematically addressed. | Screens for and addresses social vulnerabilities like isolation, economic insecurity, and caregiver stress. |
The Impact and Future of Age-Friendly Hospitals
Implementing the age-friendly hospital measure has far-reaching positive impacts beyond simply meeting a regulatory requirement. Hospitals adopting these practices report improved health outcomes for older adults, including reduced length of stay, lower readmission rates, and decreased incidence of complications like delirium and falls. Furthermore, it leads to higher patient and family satisfaction and empowers staff by giving them a clear, evidence-based framework for delivering high-quality care.
For families, choosing an age-friendly hospital can provide peace of mind, knowing their loved ones will receive care specifically tailored to their unique needs as they age. This measure creates transparency, making it easier for patients and families to make informed decisions about where to seek care.
As the population continues to age, the age-friendly measure will become a standard benchmark for hospital quality. It represents a vital step towards ensuring that our healthcare systems are equipped to provide compassionate, effective, and safe care for the growing senior population.
For more information on the broader initiative, visit the Institute for Healthcare Improvement (IHI).
Conclusion
What is the age-friendly hospital measure? It is a programmatic evaluation designed by CMS and other key healthcare leaders to assess and improve the quality of care for hospitalized adults aged 65 and older. By focusing on five key domains, informed by the 4Ms framework, the measure encourages hospitals to adopt specialized, evidence-based practices that lead to better outcomes, reduced harm, and increased patient satisfaction. This is more than just a reporting requirement; it is a movement towards a more compassionate and effective standard of care for our aging population.
