There is a simple tool to help healthcare providers understand how to create an age-friendly healthcare space.

When asking “What constitutes an age-friendly health system?,” the Institute for Healthcare Improvement (IHI) answers that with the “4Ms,” detailed below:

(What) matters. Often, older patients grew up in an era when people followed the doctor’s orders without question. “We now know it’s important to ask questions,” says Alice Bonner, PhD, RN, senior advisor on aging and innovation for IHI.

Physicians, nurses, and other healthcare providers should help these patients understand that it is important they ask questions and let providers know what is important to them personally, she adds.

Ideally, a patient would be able to express a sentiment like this: “My son wants me to have this operation, but I don’t know if I want to. Here’s what’s important to me.”

“Often, what’s important to the older person is not important for the person’s health, but it might be a family gathering,” Bonner explains. “Sometimes, they don’t want to live in a nursing home or something else, but we can’t guess what people want; we have to actually ask them.”

Medication. Often, older patients are taking several pills to treat various health maladies. When they visit the surgery center, someone should dig into their prescriptions and find out if they are taking some medications that could be discontinued, or are taking duplicate drugs or the wrong dosage for their age and health situation. “It’s important to have a real conversation about medication options,” Bonner stresses.

Mentation. It is important to assess older patients’ mental status. “One of the biggest areas that’s been overlooked for a long time is mental and behavioral health,” Bonner says. “Some older people are living with dementia, Alzheimer’s disease, or other conditions.”

In terms of mental health, as people age and cope with lifelong schizophrenia or personality disorders, healthcare professionals need some training on how to handle these challenges. “We need to do more training,” Bonner offers. “If we don’t detect a problem and try to do something about it, a patient could return home and have untreated depression.”

Mobility. “There is a lot of literature on how to prevent falls in nursing homes and hospitals by making sure there is good lighting and that people have safe footwear,” Bonner says.

Another way to prevent mobility problems and falls is to ask patients to use the restroom when they enter the surgery center, rather than waiting until after surgery, when they might be disoriented and less sure-footed.

“If you’re a surgery center nurse, you could think about how likely it is the 80-year-old man will come out of surgery and need to urinate all of a sudden,” Bonner says. “That’s a setup for falls. Make sure there’s somebody with him to take him to the bathroom and help him empty his bladder before surgery.”