The CICOA Blog

Improving Health Outcomes Through the Four Ms

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Americans spend a lot on healthcare for older adults, but we are not always happy with the results. At the recent Answers on Aging Conference, Terry Fulmer, President of the John A. Hartford Foundation, called for system change. She cited several factors for poor outcomes: poor coordination of care, duplication of services, errors during care transitions, over-medication, unnecessary hospitalizations and care that does not consider the needs of the patient.   She challenged us to do better. She called it a group effort. 

Discussions around healthcare for older adults often focus on new treatments and techniques.   Others may address the costs of care.  These conversations address efforts to close the gaps in our healthcare systems and improve health outcomes.   The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI), through the  Age-Friendly Health Systems Initiative emphasize the importance of hospitals’ working together with Area Agencies on Aging and other community-based organizations  in providing  the best care for older adults.  Collaboration is the key.

Age-Friendly Health Systems is an effort to promote collaborative care and responses that incorporate four essential elements to address the needs and wants of older adults. These are referred to as the Four Ms.  Leslie Pelton, Director for IHI’s Creating Age-Friendly Health Systems explains:

  • What Matters — Know and act on each patient’s specific health goals and care preferences. This would include, for example, learning and documenting patients’ end-of-life care wishes.
  • Medication — Optimize medication use to reduce harm and burden, focused on medications affecting mobility, mentation, and what matters. One example would be to use a criteria-driven process to identify high-risk meds for older adults (e.g., Beers or STOPP-START).
  • Mobility — Maintain movement and function and prevent complications of immobility. An essential part of this would be to implement an individualized mobility plan appropriate for each patient’s needs.
  • Mentation — Identify and manage depression, dementia, and delirium across care settings. One approach would be to minimize or eliminate potential safety risks, including psychotropic drugs, physical restraints, unlocked cabinets and doors, and fall risks.

Incorporating the Four Ms into the culture of the healthcare setting is key to establishing Age-Friendly Health Systems.  The results are happier people, better health outcomes and fewer hospitalizations for older adults.

One goal of the Age-Friendly Health Systems initiative is to promote greater engagement and collaboration with community programs.  Social programs help older adults remain active and involved in their communities, encourage health promotion activities and provide support for family caregivers. These have a positive impact on social determinants of health, which in turn helps lead to better health outcomes.     

Terry Fulmer emphasized the importance of the Four Ms in a recent blog post for the Aging and Disability Business Institute: “By working together, we can look forward to the day when our health systems, communities and all of society will be age-friendly. People will wonder why it was ever any different.” 

For more information:

The Aging and Disability Business Institute, funded in part by the John A Hartford Foundation, supports the efforts of Area Agencies on Aging, Centers for Independent Living, and other community organizations to develop sustainable service delivery models.

Read Terry Fulmer’s blog post:

Read Leslie Pelton’s blog post: