Winter 2022 Newsletter
By Robin McAtee, PhD, RN, FACHE
Director, Arkansas Geriatric Education Collaborative (AGEC)
UAMS Donald W. Reynolds Institute on Aging (DWR IOA)
The number of older adults in the United States is rapidly growing. There were 29 million adults age 65 and older in 2016. By the year 2030, adults aged 65 or greater are expected to exceed 71 million 1. Older adults utilize the US health care system more than any other age group, and our current healthcare systems have difficulty providing evidenced-based practice care in a consistent manner to older adults2.
One of the ways this issue is being addressed in the United States is through the implementation of Age-Friendly Health Systems. This is an initiative of the John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI), in partnership with the American Hospital Association (AHA) and the Catholic Health Association of the United States CHA). . This initiative is guided by a set of evidence-based practices (the 4Ms) while aligning care with what matters to older adults and their family. It is also a framework that encourages patients and their families to be full participants in their healthcare decisions. This new framework is based on the 4Ms Framework. “What Matters,” Medication, Mentation and Mobility2.
Understanding What Matters to older adults promotes meaningful healthcare goals and outcomes. It also honors a patient’s care preferences. Although what matters conversations should not be limited to discussing end-of-life care, these conversations are a good place to start asking these types of care preference questions. What Matters conversations are also a starting point for discussing advanced care planning and discerning what type of treatments and care an older adult would want if there were a sudden change in health status2.
Medications should be age friendly. This means avoiding unnecessary medications and deprescribing where appropriate. There are increased chances of side effects with age so polypharmacy should be carefully examined. Raising awareness of potential side effects to providers and patients supports increased medication safety2.
Age-friendly Health Systems strive to support care of the mind so that older adults can stay mentally sharp and do more of what matters to them. Focusing on Mentation means managing conditions like dementia, delirium, and depression. These conditions affect older adult’s ability to think clearly and make decisions. Therefore, they need to be assessed and treated and early detection and diagnosis is extremely important for effective treatment.
Supporting safe Mobility is the last 4M. Maintaining mobility greatly improves quality of life while impacting activities and helping older adults to safely live independently for as long as possible. Ensuring older adults are knowledgeable about their fall risks and taking appropriate measures to maintain and/or even improve their mobility is crucial.
Utilizing the 4Ms framework of What Matters, Medication, Mentation, and Mobility provides an effective evidenced-based care model for all older adults. This framework promotes improved health outcomes, patient safety and can be applied throughout the healthcare continuum to meet the needs of older adults2. For more information on this framework please refer to the IHI reference listed below.
1.Providing Health for Older Adults; CDC. Centers for disease Control and Prevention. (n.d.) https://www.cdc.gov/chronicdisease/resources/publications/factsheets/promoting-health-for-older-adults.htm Retrieved June 14, 2021
2. What Is an Age-Friendly Health System?: IHI. Institute for Healthcare Improvement. (n.d.). http://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/default.aspx. Retrieved June 14, 2021