What is an Age-Friendly Health System?

The team at GuideStar Eldercare is proud to be recognized as an Age-Friendly Health System. Age-Friendly Health System is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement in partnership with the American Hospital Association and the Catholic Health Association of the United States. The concept recognizes the burgeoning number of older Americans over age 65 (54 million, anticipated to become 95 million by 2060)—and it aims to improve the well-being of older adults through focused care principles.

Four out of five older adults have at least one chronic condition; 77% have at least two. This often makes care needs complex. Much is at stake. Older adults as a group have higher utilization of health services, and “experience higher rates of health-care-related harm, delay, and discoordination,” notes the AHA Center for Health Innovation.

Age-Friendly concepts

They point out, “Many individuals in this population of people live with uncertainty as they transition from living independently to reliance on others.” An Age-Friendly Health System is defined as one in which every older adult’s care:

• Is guided by an essential set of evidence-based practices (the 4Ms);
• Causes no harms; and
• Is consistent with What Matters to the older adult and their family.

The concepts offer best practices that can lead to better health outcomes for those we serve.

4Ms in Age-Friendly Health Systems

The 4Ms framework draws our focus to What Matters, Medications, Mentation, and Mobility.

What Matters means not just asking a patient, “What’s the matter?” but also asking, “What matters to you?” explains the Institute for Healthcare Improvement in its What Matters toolkit. The formal definition of What Matters is “knowing and aligning care with each older adult’s specific health outcome goals and care preferences including, but not limited to, end-of-life care, and across settings of care.”

Identifying and acting upon what matters to each patient builds relationships and “shapes the care that is provided,” says the Institute. There’s no need to dismiss the idea with a patient who is cognitively impaired, they advise. “Older adults living with cognitive impairment and dementia are often capable of expressing their goals and preferences and should participate in ‘What Matters’ conversations to the degree possible. It is the care team’s responsibility to get to know each older adult and engage with him or her directly.”

It can help to choose a patient’s most lucid moments, advises the Institute. A caregiver can also find out “who the older adult relies most on to help make decisions,” and use that person as a resource. Paying attention to nonverbal communication is valuable, as well. The Institute’s toolkit provides sample questions for What Matters conversations.

You can anchor treatment choices in a patient’s goals and preferences by asking questions such as, “What is the one thing about your health care you most want to focus on so that you can do [fill in desired activity] more often or more easily?” or “What are your most important goals if your health situation worsens?” suggests the Institute.

Antipsychotic reduction in Age-Friendly Health Systems

Antipsychotic reduction has significant impact on the 4Ms in Age-Friendly Health Systems. Consider these components of the 4Ms:

• The Medications M states: “If medications are necessary, use age-friendly medications that do not interfere with What Matters, Mentation or Mobility.” Needless to say, this tenet is in direct contrast to findings that dangerous antipsychotics are still prevalent in nursing homes, which do interfere with quality of life. Systematically reducing antipsychotic use can be achieved with a neurology-forward approach and proven clinical models.
• The Mentation M states: “Prevent, identify, treat and manage depression, dementia and delirium across settings of care.” With many of the patients we serve, we help manage challenging neuropathologies and BPSDs related to dementia. A qualified, interdisciplinary team is essential to assess and treat mental health conditions as well as cognitive impairments.
• The Mobility M states: “Ensure that older adults move safely every day in order to maintain function and do What Matters.” Supporting safe functionality can encompass ideas from environmental design to techniques and aids that allow each patient to achieve maximum mobility. Also consider the impact of antipsychotic reduction. Antipsychotic drugs can cause orthostatic hypotension, sedation, and extrapyramidal symptoms; they can increase the risk of falls and fractures, report Wang et al. Avoiding unnecessary medication is essential to mobility and functioning.

Nursing homes are successfully reducing antipsychotic usage with the Antipsychotic Stewardship program from GuideStar. In doing so, they are advancing the health outcomes of their residents. What are your challenges in implementing Age-Friendly Health Systems? Our multidisciplinary team is here to support you. Get in touch today.