As you get older, your medical care can ripple across every aspect of your life. It might be a prescription that makes you too tired for dinner with the family. You may love bowling, but a hip replacement has kept you off the lanes much longer than you expected. You might feel sad and withdrawn from friends, unsure if it’s depression or because you can’t hear as well anymore.
In all of these examples, your health care providers can likely do more to help manage these issues than they do now.
Putting Patients Front and Center
The good news is that change in how doctors treat older adults is happening right now. A growing number of hospitals and health systems in the United States are part of an important new movement that puts the voices of older patients front and center in an effort to transform health care. It’s known as the Age-Friendly Health Systems initiative, and it focuses on four essential elements of caring for older adults, called the 4Ms:
- The first M is “what matters.” Everyone on a patient’s health care team should listen -- really listen -- to their patients so they understand and can act upon that patient’s goals and care preferences, which change as we age.
- The second M is “mentation.” Mentation is about your mental status and concerns preventing, identifying, treating, and managing dementia, depression, and delirium (a sudden state of confusion).
- The third M is “mobility.” This puts a priority on moving safely every day to maintain function and independence in every setting of care. Mobility, whether in the ICU or the home, ranges from getting out of bed to walking the dog and everything in between. Plans for care should consider a person’s mobility level and strive to maintain or improve it.
- The final M is “medication.” If medications are necessary, doctors and nurse practitioners should prescribe what we call “age-friendly medications” that do not interfere with what matters, mentation, or mobility.
To make all health systems age-friendly, we need two things:
You Decide What’s Best for Your Health
First, we all need to take an active role in our health care, telling our doctors and nurses what matters most to us and what health goals we want to achieve. Too many people have been conditioned to let health care professionals take the steering wheel while passively trusting them to decide what’s best for their health. This leads to unanswered questions and unexplored options. It can be scary at first, but it is essential to speak up. This guide from Patient Priorities Care can help you determine what matters most to you and how best to make those wishes known to your health care team.
For example, if what matters most is planting a garden in the early spring, tell your doctor. The treatments and medications the doctor recommends may change by knowing this is your goal. You might postpone your hip surgery or develop a different physical therapy plan to maintain your mobility.
Even though it was once taboo, discussing memory and mental health issues with your health care providers is imperative. Any signs of fuzzy memory or confusion should be addressed. Tell your doctors or nurse practitioners about your medications and how they make you feel. More than 4 in 10 older adults take five or more prescription medications a day, and dangerous medication interactions are unfortunately common. Overprescribing is also a problem. If your medications aren’t helping you achieve your goals, then they should be reconsidered.
Second, health systems need the training and tools to make sure the 4Ms are addressed in every interaction with older patients. The John A. Hartford Foundation is working with health care partners right now to make sure this happens. As of March 2022, more than 2,500 hospitals, medical practices, and long-term care organizations have been recognized by the Institute for Healthcare Improvement for their commitment to age-friendly care, including CVS Health’s MinuteClinic locations.
The outdated idea of thinking about “what’s the matter with you?” must give way to “what matters to you” as people live longer than ever. This is a goal of the Age-Friendly Health Systems initiative. Hospitals and health systems are doing that by making sure the 4Ms are present across every setting of care, whether it’s in the home, hospital, clinic, emergency room, or long-term care facility.
Patients have a key role to play. While doctors and nurses are the qualified experts to provide care, every patient is an expert in their own lives and what matters most to them.
For more resources on age-friendly care, visit johnahartford.org/agefriendly.
(A version of this article, by Terry Fulmer, PhD, RN, FAAN, president of The John A. Hartford Foundation, originally appeared on Next Avenue.)
Institute for Healthcare Improvement: "Health Systems Recognized by IHI."
CVS Health: "Age-friendly care for older adults."
Lown Institute: “Medication overload and older Americans.”
Patient Priorities Care: “Conversation Guide for Patients and Caregivers for Identifying Their Health Priorities.”