What Defines an Age-Friendly Measure?
An age-friendly measure is a formal assessment of how well an environment, such as a community or health system, is adapted to the needs and preferences of older adults. Given the aging global population, these measures are vital for supporting healthy and dignified aging. Frameworks extend beyond basic accessibility to include social, psychological, and economic factors, impacting quality of life for older adults. The World Health Organization (WHO) and the Institute for Healthcare Improvement (IHI) offer prominent frameworks for age-friendliness in communities and health systems, respectively.
The WHO's Age-Friendly Cities Framework
The WHO's Global Age-Friendly Cities and Communities framework is a widely recognized standard for evaluating community age-friendliness. It assesses eight interconnected domains influencing the well-being and participation of older people in urban and community life. Community assessments often involve evaluating services and gathering feedback through surveys and focus groups. The eight domains are outlined by the WHO and include areas such as outdoor spaces and buildings, transportation, housing, social participation, and access to health services. A full list of these domains can be found on the {Link: WHO website https://www.who.int/europe/initiatives/age-friendly-environments-in-europe-(afee)}.
The IHI's Age-Friendly Health Systems and the 4Ms Framework
For healthcare settings, the IHI, with partners like the John A. Hartford Foundation, developed the Age-Friendly Health Systems (AFHS) initiative. This framework focuses on consistently applying the 4Ms of age-friendly care for all older adults within a health system. The Centers for Medicare & Medicaid Services (CMS) also introduced an Age Friendly Hospital Measure, based on the 4Ms, to assess hospital commitment to improving care for patients 65 and older across five domains. The 4Ms include:
- What Matters: Aligning care with the health preferences and goals of older adults, including end-of-life wishes.
- Medication: Reviewing and managing medications to ensure they align with the older adult's health goals and minimize inappropriate use.
- Mentation: Screening and managing cognitive impairment (dementia, delirium) and depression.
- Mobility: Promoting early and frequent movement to maintain function and prevent decline.
Community vs. Healthcare Age-Friendly Measures
Both community and healthcare age-friendly measures aim to improve older adults' lives but focus on different environments with distinct strategies. Below is a comparison:
| Feature | Community Age-Friendly Measures (WHO) | Healthcare Age-Friendly Measures (IHI/CMS) |
|---|---|---|
| Primary Focus | Physical and social environment of a city or town to support aging in place and social engagement. | Clinical care for older adults within health systems. |
| Key Domains | 8 interconnected domains (e.g., transport, housing, social participation). | The 4Ms: What Matters, Medication, Mentation, and Mobility. |
| Evaluation Method | Community assessment using surveys, focus groups, and public engagement. | Evidence-based protocols, screening tools, and tracking metrics. |
| Goals | Create inclusive and supportive environments that promote healthy aging and participation. | Improve patient outcomes, reduce harm, and align care with older adults' priorities. |
| Key Outcome | Improved quality of life and health outcomes in a specific geographic area. | Reduced hospital stays, prevention of readmissions, and better management of geriatric conditions. |
Conclusion
Age-friendly measures offer valuable frameworks for communities and health systems to create supportive environments for older adults. The WHO's community-focused approach and the IHI's 4Ms for healthcare provide clear guidance for assessment and improvement. Implementing these measures benefits older individuals and contributes to more inclusive environments for all. Utilizing age-friendly measures is crucial for addressing the needs of an aging population and fostering a healthier, more equitable future.
For more information on the Age-Friendly Health Systems and the 4Ms framework, visit the Institute for Healthcare Improvement website.
The Role of Assessment in Measuring Age-Friendliness
Effective implementation of age-friendly measures relies on both objective and subjective assessment. Communities often follow a cycle of assessment, planning, action, and evaluation, as suggested by organizations like the WHO and AARP. This can involve surveys on service quality and accessibility, along with data collection on infrastructure. In healthcare, the AFHS uses standardized screening tools for the 4Ms and tracks data on quality indicators to drive improvements. These structured assessments allow for consistent measurement of progress and comparison across different settings.
Example Indicators and Implementation
Age-friendly measures utilize specific indicators to gauge success. Community indicators, based on frameworks like the WHO's, may include objective metrics such as the availability of parks with benches or accessible public buildings. Subjective indicators from surveys might measure perceived safety or social inclusion. For health systems, the CMS Age Friendly Hospital Measure includes domains like leadership commitment and protocols for patient goal elicitation. The 4Ms implementation involves using validated tools like the Mini-Cog for mentation screening or the Timed Up and Go (TUG) test for mobility. Tracking these indicators helps organizations meet requirements and identify areas for improvement that impact older adults' lives.
