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Age-Friendly Health Systems
Share PrintAge-Friendly Health Systems provide care to older Veterans based on What Matters. The 4Ms (What Matters, Medication, Mentation, and Mobility) are a framework to provide Veteran-centric care focused on What Matters across all care settings. Age-Friendly Health Systems is a high-reliability approach to continuously improve care and achieve zero harm.
Origin:
April 2017, Institute for Healthcare Improvement
Adoptions:
88 successful, 60 in-progress
Partners:
Diffusion of Excellence
Recent Updates
Overview
Problem
The number of Veterans age 65 and older is rapidly growing. Older Veterans are a clinically complex population with significant health care needs – including care for chronic health conditions linked to military service. Hospitals and health systems are frequently unprepared for this complexity, and older Veterans suffer a disproportionate amount of harm (ex
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The number of Veterans age 65 and older is rapidly growing. Older Veterans are a clinically complex population with significant health care needs – including care for chronic health conditions linked to military service. Hospitals and health systems are frequently unprepared for this complexity, and older Veterans suffer a disproportionate amount of harm (ex. length of stay, hospital readmissions, adverse drug events, delirium, isolation and depression, falls, etc.). To address these challenges, Age-Friendly Health Systems follow an essential set of evidence-based practices know as the “4Ms” – What Matters, Medications, Mentation, and Mobility. When implemented together, the 4Ms represent a cultural transformation to focus on aligning care with What Matters to older Veterans.
See
more
Videos
Identifying What Matters to Patients: Where Age Friendly Care Starts
Solution
The 4Ms are a framework, not a program, to organize and focus care on the older Veteran’s wellness and strengths rather than solely on disease. By understanding What Matters, each older Veterans’ care plan is aligned with their care preferences and unique health outcome goals, often eliminating unnecessary or unwanted care. The 4Ms are meant to streamline ex
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The 4Ms are a framework, not a program, to organize and focus care on the older Veteran’s wellness and strengths rather than solely on disease. By understanding What Matters, each older Veterans’ care plan is aligned with their care preferences and unique health outcome goals, often eliminating unnecessary or unwanted care. The 4Ms are meant to streamline existing programs and initiatives to build on the great care already provided to Veterans through quality improvement. Age-Friendly Health Systems can be implemented in any care setting. The quality of 4Ms care provided may be tracked via the VA Age Friendly national dashboard released for internal use in October 2023.
See
more
Videos
Recommendations for Making Care More Age-Friendly
Results
The 4Ms framework identifies clear assessment and action steps to improve care for older Veterans. The 4Ms help all members of the Veteran’s care team to assess, document, and act on the 4Ms as a set. The 4Ms allow customization for specific care settings. Some care settings may already have some elements of the 4Ms in place; however, it’s important to maint
...
The 4Ms framework identifies clear assessment and action steps to improve care for older Veterans. The 4Ms help all members of the Veteran’s care team to assess, document, and act on the 4Ms as a set. The 4Ms allow customization for specific care settings. Some care settings may already have some elements of the 4Ms in place; however, it’s important to maintain, improve, and expand on the 4Ms where necessary. The key is to ensure that these practices are reliable — the goal of Age-Friendly Health Systems is to make sure that the 4Ms are happening every time in every setting for every older Veteran served.
See
more
Videos
Arthur’s team at the Salt Lake City VA Medical Center are working to get him back to his favorite pastime – fishing in Alaska.
Metrics
- Number of patients 65+ who receive 4Ms care. In progress= IHI participant recognition in 1+ care setting. Successful=Committed to Care Excellence recognition in 1+ care setting.
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Multimedia
Videos
VA Age-Friendly Summit 2023
Implementation
Timeline
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Understand your current state
First, conduct a current state assessment at your facility. Identify where the 4Ms are already in practice. Where are your bright spots? Who are your champions?Select a care setting where you’d like to get started. Questions to consider: How many older Veterans are served in this care setting? Is there a local champion? Can this setting be a model for the rest of the hospital/health care system? Are there team members who have experience with the 4Ms, either individually or combined? Do you already have processes and tools in place to support the 4Ms? Once you’ve selected a care setting, set up your Age-Friendly team. -
Create a 4Ms plan
Using the 4Ms Care Description Worksheet, describe a plan for how your team will provide care consistent with the 4Ms. This worksheet helps you to assess, document, and act on the 4Ms as a set, while customizing the approach to practicing the 4Ms for your context. As you test the 4Ms, you may make updates to your 4Ms plan based on what you learn about the tools and methods that work best for your team. Questions to consider: How does your current state compare to the actions outlined in the 4Ms Care Description Worksheet? Which of the 4Ms do you already practice? How reliably are they practiced? Where are there gaps in 4Ms? What ideas do you have to fill the gaps? Once you've create a 4Ms plan, you can provide this information via email to IHI to achieve Age-Friendly Participant recognition. -
Design and adapt your workflow
Look for opportunities to combine or redesign activities, processes, and workflows around the 4Ms. In this effort you may find that you can stop certain activities and shift resources to support Age-Friendly care. -
Provide care
Learn as you move toward reliable 4Ms care. Begin to test the key actions described in your 4Ms plan with one older Veteran and their family or other caregivers. Use the Plan-Do-Study-Act (PDSA) process to learn more from your tests and improve 4Ms care. Scale up your tests to include more Veterans and modify your 4Ms plan if needed. -
Study your performance
How reliable is your 4Ms care? What impact does your 4Ms care have? Directly observe your 4Ms plan in action. Can your team follow the 4Ms Care Description and successfully assess and act on the 4Ms with the older Veteran in your care? Does the Veteran’s care plan reflect 4Ms care? Consider asking your team at least once per month for the first seven months of your efforts, two open-ended questions and reflect on the answers: What are we doing well to assess and act on the 4Ms? What do we need to change to translate the 4Ms into more effective care? Consider asking your Veterans and their families or caregivers two open-ended questions and reflect on the answers: What went well in your care today? What could we do better to understand what Age-Friendly care means to you? -
Improve and sustain care
As you establish Age-Friendly care at your facility, you may cycle through these steps many times over the course of several months in order to achieve reliability and then turn your efforts to sustainability and monitoring (quality control) over time. Begin measuring the number of Veterans over age 65 who receive 4Ms care. To achieve Committed to Care Excellence recognition, teams need to provide three months of counts for the number of older adults receiving all 4Ms (as described in the 4Ms Care Description submitted to IHI for Participant recognition).
Departments
- Mental health care
- Social work
- Emergency care
- Extended care and rehabilitation
- Pharmacy
- Geriatrics
- Hospital medicine
- Physical medicine and rehabilitation
- Primary care
- Whole health
Core Resources
| Resource type | Resource description |
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PEOPLE |
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PROCESSES |
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TOOLS |
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Links
- Link to IHI 4Ms Care Description Worksheets to earn Age-Friendly Health Systems Participant recognition Recognition
- Internal VA link to register for the 2025 VA Action Community. Action Communities provide a series of monthly webinars and coaching calls to support teams on their Age-Friendly journey. Mark your calendar for our kick-off Call on December 12 at 2pm ET! From January to July 2025, the FY 2025 VA Age-Friendly Action Community will host monthly webinars (second Thursdays) and coaching calls (fourth Thursdays) at 2pm ET. Join the 2025 VA Action Community
Support Resources
Links
- Health Services Research article on Age-Friendly Health Systems in VHA Age-Friendly Health Systems: Improving care for older adults in the Veterans Health Administration
Contact
Comment
Comments and replies are disabled for retired innovations and non-VA users.
Email agefriendly@va.gov with questions about this innovation.
About
Origin story
In FY20, the VHA Office of Geriatrics and Extended Care (GEC) identified Age-Friendly Health Systems as a strategy to “Modernize Systems for Healthy Aging.” Modernize Systems for Healthy Aging is one of the six workstreams that comprise GEC’s Transformation Plan, a four-year strategic plan designed to transform how VA delivers Veteran-centric care to older V
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In FY20, the VHA Office of Geriatrics and Extended Care (GEC) identified Age-Friendly Health Systems as a strategy to “Modernize Systems for Healthy Aging.” Modernize Systems for Healthy Aging is one of the six workstreams that comprise GEC’s Transformation Plan, a four-year strategic plan designed to transform how VA delivers Veteran-centric care to older Veterans. GEC joined the Age-Friendly Health Systems movement in March 2020 and has set the aim for VHA to become the largest integrated health care system in the U.S. to be recognized by IHI as Age-Friendly. 186 VA Age-Friendly teams participated in the VA Fall 2022 Action Community.
Original team
Kim Church, MS
National Lead for Age-Friendly Health Systems, VHA Office of Geriatrics and Extended Care
Marianne Shaughnessy, PhD, CRNP
Director, Geriatric Research Education Clinical Centers (GRECCs)
Tom Edes, MD
Senior Medical Advisor, VHA Office of Geriatrics and Extended Care
Laurence Solberg, MD AGSF
Geriatrician, North Florida/South Georgia Veterans Health System, Gainesville GRECC
Troy.wilder@va.gov Strategic Planner looking for assistance to adopt this at a rural Healthcare System
@Troy - email coming your way!
This is an exciting movement and our office, Diffusion of Excellence, hopes to help spread the word!