Age-Friendly Health Systems: A Welcome Innovation for Older Patients & Caregivers

A nurse taking a patient’s blood pressure

If you accompany your parent or family member to doctor's appointments, you may have felt at times like the healthcare system simply isn't optimized for the needs of older patients. This is by no means a criticism – primary care practices and specialists alike see a wide range of patients and they must serve them all.

However, it's impossible to avoid the demographic reality. The U.S. Census' National Population Projections 2017 estimate that by 2035, adults over 65 will outnumber children. In response, The John A. Hartford Foundation, the Institute for Healthcare Improvement (IHI), the American Hospital Association, and the Catholic Health Association of the United States are joining forces to proactively promote age-friendly health systems.

What is an Age-Friendly Health System?

The foundation of an age-friendly health system is the "4Ms Framework." The 4Ms are:

  1. What Matters. Age-friendly health systems align care with each older adult's specific health outcome goals and care preferences across care settings. This includes, but isn't limited to, end-of-life care.

  2. Medication. Age-friendly health systems strive to use "age-friendly" medications across care settings that don't conflict with the other 3Ms.

  3. Mentation. Age-friendly health systems prevent, identify, treat, and manage dementia, depression, and delirium across care settings.

  4. Mobility. Age-friendly health systems focus on mobility, so older patients can move safely every day to maintain function and to continue to do What Matters for them.

To be effective, the 4Ms must be implemented together and they must be practiced reliably across all older patients, in all settings, and in every health system interaction. Age-friendly health systems accomplish this in two ways. They assess – that is, they understand the 4Ms for each older patient in their care. They also "act on" – they integrate the 4Ms into older patients' care plans.

Building Momentum for Age-Friendly Health Systems

The organizations spearheading the age-friendly health systems movement have a goal to implement the 4Ms framework at 20% of U.S. hospitals and medical practices by the end of 2020 – this represents 1,000 hospitals and 1,000 primary care practices.

Five leading health systems volunteered early in the project and their testing resulted in the evidence-based 4Ms framework for age-friendly care. These pioneering systems include:

  • Anne Arundel Medical Center

  • Ascension

  • Kaiser Permanente

  • Providence St. Joseph Health

  • Trinity Health

In September 2018, the IHI Age-Friendly Health Systems Action Community Wave 1 was launched, comprised of 131 sites of care from 73 organizations. Action Community Wave 2 began in April 2019 and included 153 sites of care from 94 organizations. Work is now underway to recruit organizations for the next Action Community.

Age-Friendly Health System Innovations

During a webinar on August 1, 2019, organized by the American Hospital Association, Angela Fox, Director of Business Development and Implementation for Providence Health & Services, highlighted a variety of tactics that her organization has used to cultivate an age-friendly health system.

One of the most interesting is the creation of primary care “geriatric champions.” The organization's Geriatric Mini-Fellowship program is a four-week program. Physicians and nurse practitioners interested in becoming a geriatric champion attend all-day classes taught by a geriatrician, a geriatric nurse practitioner, a Doctor of Pharmacy, and guest faculty. Each week, the program focuses on one of the 4Ms. The health system now has 12 geriatric champions (11 MDs and 1 nurse practitioner) in 12 clinics serving 28,000 seniors.

The health system is also strengthening the "What Matters" conversations that occur between providers and patients. The organization has created a "What Matters Conversation Guide" with resources, guiding questions, and steps for starting the dialogue.

Implications for Seniors and Caregivers

The age-friendly health systems movement is encouraging both for older patients, as well as their caregivers. I, for one, would have welcomed a geriatric champion when I was helping to care for my Dad. A few recommendations for caregivers include:

  1. Inquire whether your family member's primary care practice is aware of the age-friendly health systems model and share information with them, if they aren't.

  2. Ask your family member if they would be willing to proactively start the "What Matters" conversation with healthcare providers, even if the health system isn't officially "age-friendly."

  3. Engage healthcare providers in a dialogue around your family member's medications. Are they appropriate for your family member's life goals, mobility, and cognitive well-being?

Grassroots encouragement from patients and caregivers can only build additional momentum for this important healthcare trend.

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