By Jason A. Smith, Author

With thousands of people across the United States reaching age 65 and older every day, hospitals and health systems are looking for ways to improve care for these patients and better suit their needs.

Terry Fulmer, PhD, RN, FAAN, is the president of The John A. Hartford Foundation (JAHF), which has worked extensively in addressing the healthcare needs of older patients. Fulmer touted the success of the Age-Friendly Health Systems program as a way to meet those needs.

“The Age-Friendly Health Systems initiative is really a movement to transform healthcare so that each of us reliably gets the best care possible as we age that reduces harm, increases our satisfaction, and creates value for everyone from the patient to the health system CEO to the bedside nurse,” says Fulmer.

The initiative was launched in 2015 with JAHF’s partners at the Institute for Healthcare Improvement, in collaboration with the American Hospital Association and the Catholic Health Association of the United States.

“Our goal is to develop an Age-Friendly Health Systems framework and rapidly spread to 20% of U.S. hospitals and health systems by 2020,” says Fulmer. “The heart of the initiative is what we call the ‘4Ms’ bundle, which we distilled from the evidence about the best care of older adults.”

The 4Ms bundle centers on implementing effective strategies of care for older patients:

  • What Matters: understanding and aligning care with what is most important to each patient;
  • Medication: using appropriate prescriptions that do not interfere with What Matters;
  • Mentation: preventing, identifying, treating, and managing delirium, dementia, and depression;
  • Mobility: promoting safe and regular movement to preserve function.

“Together, addressing these 4Ms across all care settings can measurably improve the experience and outcomes of care for older adults and their families,” says Fulmer.

In 2017, five health systems adopted the Age-Friendly system: Anne Arundel Medical Center in Maryland, Ascension network, Kaiser Permanente, Providence St. Joseph Health system, and Trinity Health in Michigan. Fulmer says the initiative has yielded positive results.

“More than 100,000 patients have received age-friendly healthcare at 26 sites within those systems in seven states,” she explains. “We are seeing examples of improvement and continue to collect data to show outcomes.”

For example, at Anne Arundel Medical Center, “staff integrated the 4Ms into shift reports, incorporated ‘What Matters’ into the electronic health records and whiteboards in hospital rooms, and began daily exercise sessions for their older patients,” Fulmer explains. “In their pilot, they reported reductions in length of stay and increases in patient satisfaction.”

Overall, Fulmer says the healthcare community has responded with a “groundswell of interest and buy-in” to the strategies involved in this initiative. “More than 250 organizations have joined quarterly ‘Friends of Age-Friendly’ update calls,” she adds.

Fulmer explains that as recently as September 2018, more than 120 teams from 69 health systems have joined an Age-Friendly Health System Action Community in a collaborative effort to learn how best to implement the 4Ms.

“The concept of age-friendly care is something that everyone understands and sees its value,” she says.

In addition to positive reaction from those in the healthcare field, Fulmer says the initiative from patients has been “validating” as well. Patients and their families have expressed higher levels of satisfaction regarding their care since the initiative was implemented.

“We have patient representatives who have been helping design the initiative,” says Fulmer. “They often talk about how incredibly different care is when their healthcare team is focused on what matters to them as people, rather than only focusing on what’s the matter with them as patients.”

Fulmer also laments the rising cost and demand of healthcare for people age 65 and older, citing a need for a system that creates value and continuity for patients.

“By focusing on what matters and preventing harm by using the 4Ms as a guide, we can reduce waste and inefficiency in our system,” she says. “Simultaneously, this can increase patient and family satisfaction and bring more joy to members of the healthcare team who want to see their older patients, and all of their patients, have positive outcomes.”

Fulmer says the John A. Hartford Foundation, established in 1929, has played an essential role in helping to improve care for older adults for more than three decades.

“Through our grants and programs, we’ve helped build a field of experts in aging and health, and today, we’re focused on replicating their innovative approaches and achieving measurable impact.”

Along with its work in age-friendly health systems, Fulmer says the foundation has maintained a focus on “supporting family caregivers of older adults and improving serious illness and end-of-life care.”

Practicing the 4Ms

Lillian Banchero, MSN, RN, senior director at the Institute of Healthy Aging at Anne Arundel Medical Center in Annapolis, MD, says working to meet the needs of older patients is an increasingly important issue due to the changes in demographics across the country.

“There’s 10,000 people who turn 65 every day,” says Banchero. “We as healthcare providers need to understand that our population is changing to age 65 and older. Older adults have different medical needs and social needs.”

Anne Arundel Medical Center signed on to the Age-Friendly Health System Initiative nearly two years ago. Banchero says JAHF and IHI have teamed up in recent years with organizations across the country with the goal of improving the level of patient care.

“Age-friendly healthcare is all about giving people the best care we can give, without harm, and reducing costs,” says Banchero.

She points to elements of the 4Ms bundle to illustrate the priorities of the Arundel health system as a means of patient care.

“The most important ‘M’ to us is What Matters,” says Banchero. “Once we understand what matters to them in their care, we can provide the best individual care for them.”

Banchero also emphasizes the Mobility and Mentation components of the 4Ms as crucial elements in caring for older patients. She says patients who exercise and interact with their peers have a greater likelihood of better health.

“Sometimes with older people, we think they just need to stay in bed. It’s just the opposite,” says Banchero. “If you’re locked away in a room for two or three days and nobody’s talking to you, that’s no good for you. You need to get up and walk, say hi to somebody, have interaction with each other. It’s just as important as any medication or treatment we can give you.”