Are You Missing Opportunities to Improve Care for Older Adults?
Less than 10 percent of the total health requirements for older adults is being met in the United States, despite evidence-based models of care, such as PACE (Programs of All-Inclusive Care for the Elderly), ACE (Acute Care of the Elderly) units, and GRACE (Geriatric Resources for Assessment and Care of Elders) being available. The Institute for Healthcare Improvement (IHI) believes that better use should be made of the evidence and best practices that could be established for older adults’ care. Working alongside the John A. Hartford Foundation, the organization has invited health systems, researchers and physicians to create a model of care that can encompass all needs of older adults. Four key interventions have been determined as essential for older adult care: What Matters – each patient’s health goals and care preferences being taken into account; Medication – Optimized medication use; Mobility – maintaining function and movement and preventing mobility complications; and Mentation – managing depressions, delirium and dementia to reduce safety risks. The IHI has created a self-assessment tool for organizations to determine whether they are doing the maximum to meet these key interventions, and is working on the Creating Age-Friendly Health Systems (CAFHS) initiative prototype.

It should be great news. The US knows what kind of care to provide for older adults. We have PACE (Programs of All-Inclusive Care for the Elderly) programs in hospitals and communities, ACE (Acute Care of the Elderly) units in hospitals, and GRACE (Geriatric Resources for Assessment and Care of Elders) in hospitals, for example.

The problem is that even though we know what care to provide for older adults, we meet less than 10 percent of the total need in our country with the best evidence-based models of care available. This means that the majority of older adults in the US could be getting care that is unnecessary, ineffective, or harmful. And we know how to prevent this. But too often we don’t.

At IHI we see this as a classic failure of implementation. We understand what it will take to improve the lives of 46 million adults over age 65 in the US today, but we don’t reliably use the best evidence and implement the best practices for every older adult, every time.

Learn more about the

Consequently, the John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) invited leading researchers, physicians, and health systems to develop a model to reliably provide the best care possible for older adults every day and everywhere they encounter the health care system. We reviewed hundreds of articles and care models to find the most effective ways to create what we call an “age-friendly” health system — one that will measurably improve the quality of care for older adults and optimize value for health systems.

We’ve determined that four key interventions are essential to create an age-friendly system of care. If care providers consistently do these four things for every older adult, every time, across care settings, we believe we will save lives and avoid harm. We call them the 4Ms: