++
Learning Objectives
Articulate the importance of the 4Ms in health care for older adults.
Discuss the evidence and approaches for acting on each of the 4Ms: What Matters, Medication, Mentation, and Mobility.
Understand the intersection of team care required in the 4Ms approach.
++
Key Clinical Points
Team-based geriatric care is critical to the delivery of comprehensive, coordinated health care to older adults, their families, and caregivers.
The Age-Friendly Health Systems movement is an evidence-based approach to care that when implemented reliably, improves quality, improves health, and reduces costs.
The 4Ms set, What Matters, Mentation, Medications, and Mobility, provides a framework that addresses the multiple intersections of each of the 4Ms.
++
With an unprecedented acceleration of the population living successfully into old age, the reimagining of the health care system is an imminent and compelling responsibility. There is an urgency to reform the fragmented delivery of health care to improve continuity across care systems as well as to adopt a unifying framework that is readily understood and implemented universally by providers and patients alike. Patients and families want respect and compassion, to learn about what to expect about their health and health care, and to be able to have a strong sense of trust in their caregivers and institutions.
++
Reliable team approaches are essential, given the complexity of our systems. Interprofessional team (IPT) care is essential to providing effective care for older adults with multiple conditions and functional decline. Research has demonstrated that IPT care is associated with enhanced functional and cognitive status, reduced depression, and improved subjective well-being. IPT care has also been shown to reduce hospital readmissions and outpatient service use. Specialized IPTs focusing on specific conditions such as congestive heart failure, stroke, myocardial infarction, or dementia have also demonstrated improved patient outcomes in older adults.
++
The current and projected health care workforce shortage, coupled with the aging of the population, mandate that care models be measurably efficient and effective. The increasing number of frail older adults with complex needs demands widespread adoption of geriatric IPTs. In this chapter, the Age-Friendly Health Systems (AFHS) movement, coupled with the essential elements of team-based care, are discussed as a way forward and new standard of care.
+++
High-Functioning Teams as a Prerequisite to AFHS and 4Ms Care
++
Through the collaborative efforts of The John A. Hartford Foundation (JAHF) and the Institute for Healthcare Improvement (IHI), in partnership with the American Hospital Association (AHA) and the Catholic Health Association of the United States, the AFHS initiative has had strong momentum (Figure 12-1). Already established in over 2,600 sites of care across the country, this progress indicates a willingness to adopt the 4Ms model and study the impact. The AFHS movement has the goal of reaching 25% of hospitals and primary care settings by 2025.
+...