Recognizing that the current U.S. health system is not well prepared to care for the rapidly aging population, the Institute for Healthcare Improvement (IHI) and the John A. Hartford Foundation are partnering with the American Hospital Association and the Catholic Health Association of the United States on the Age-Friendly Health Systems initiative. Tam Duong, MSPH, a senior project manager and research associate at the IHI, outlined what the initiative entails during an IHI-sponsored presentation called “Assessing the value of age-friendly health care” on June 13.1

“We know that in the current system, older adults experience harm and may not receive care that is consistent with what matters to them,” Duong noted. “[However], the good news is we know there are evidence-based models for effective geriatric care. At IHI, we saw this as an opportunity to increase the reliability of these models to achieve better outcomes for older adults.” Initiative developers hope to build a movement to ensure that all the care provided to older adults is age-friendly. “That means that the care is evidence-based, causes no harm, and sticks with what matters to the older adults and their families,” Duong noted. “The first goal that we set is that by the end of 2020, 1,000 hospitals and 1,000 primary care practices will be age-friendly.”

To get there, the initiative is focusing on what program developers refer to as the 4Ms framework, a series of interrelated priorities:

  • What matters refers to the need to align care with what older adults desire in terms of health outcome goals and preferences across all settings of care. Duong noted that this first “M” is viewed as the foundation of age-friendly care;
  • Medication refers to using age-friendly medicines that do not produce results that do not produce results that are contrary to the wishes of older patients or that negatively affect their mobility or mental status. It also means understanding and reducing medications that pose higher risks for older patients;
  • Mentation refers to the prevention, treatment, and management of dementia, depression, and delirium;
  • Mobility pertains to the need to ensure that older adults can move safely, maintain function, and carry out tasks that are important to them.

Implementation of the framework has been assessed in five health systems across the country. “These systems have tested the four Ms and gave us detailed insight on how to make them work,” Duong explained, noting that all of this guidance is available to health systems online ( “Also on our website, we have outlined how [an organization] can become recognized as an age-friendly health system.”

Further, although there is a strong moral case for engaging in this work, Duong noted that the initiative recognizes hospitals operate in a business environment. Consequently, a financial case must be made to further the initiative’s age-friendly care goals, she said.

To that end, the initiative worked with Victor Tabbush, PhD, an adjunct professor emeritus at the UCLA Anderson School of Management, to build a business case for the 4Ms framework, along with two return on investment calculators that healthcare systems can use to assess the returns from their own age-friendly care efforts. One calculator is designed for inpatient activities, while the other is focused on measuring results on the outpatient side.

Both calculators, along with other tools and information about making the business case for age-friendly care improvements, are available online at:


  1. Institute for Healthcare Improvement (IHI). WIHI: Assessing the Value of Age-Friendly Health Care. Available at: