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 Q&A: How the Age-Friendly Health Systems Initiative Works

Terry Fulmer, PhD, is president of The John A. Hartford Foundation based in New York City. Among the many issues the group focuses on is its signature effort, the Age-Friendly Health Systems initiative.

The foundation is working with the Institute for Healthcare Improvement (IHI) in partnership with the American Hospital Association and the Catholic Health Association of the United States to develop a framework for the program’s implementation in 20 percent of U.S. hospitals and health systems by 2020.

At its core, the effort is focused on the “4 M’s” for age friendliness:

--What Matters: Know and align care with each older adult’s specific health outcome goals and care preferences, in​clu​ding, but not limited to, end-of-life care and across settings of care.

--Medication: If medication is necessary, use Age-Friendly medications that do not interfere with What Matters to the older adult, Mobility, or Mentation across settings of care.

--Mentation: Prevent, identify, treat, and manage dementia, depression, and delirium across settings of care.

--Mobility: Ensure that older adults move safely every day in order to maintain function and do What Matters.​​

Below, Fulmer tells Provider how the program works and how it got started.

Provider: What is this initiative all about?

Fulmer: It began when I took on the presidency of John Hartford, some two to three years back. But the notion of age-friendly really started in 2008 with the WHO [World Health Organization] talking about age-friendly cities. And, I thought it would be very important to use the same moniker because people understood it ...

Age-friendly cities are great, but we should have age-friendly health systems that take excellent care of you from the kitchen table through the emergency room and back home safely. And, that is what we are driven to do.

Provider: What are the goals of the program?

Fulmer: We knew that we wanted to take evidence that has been generated over the past many years, say three decades of evidence-based best practices in geriatrics, and make sure that we could embed them into practice in a seamless, reliable way. About this time a foundation reached out to the IHI in Boston and said, will you work with us, and we are thrilled that they are doing this work with us.

The means of the program are that every older adult will get an evidence-based set of essential practices, we call them the 4 M’s [see above].

Provider: What is the problem now when it comes to these issues in the hospital setting, and have you had success in getting the message out?

Fulmer: I think the fundamental issue is that we have pockets of excellence of care around the country, but not reliable care for older adults that will take on these 4 M’s. They are essential to the well-being of older people, and if you get one wrong, say you get medication wrong, I guarantee you your other M’s will go off the rails.

We say to health systems, use the set of practices. We will give you the assessment tools, we will work with you to collect data and show how you can improve care for older adults across your system.

We started with hospitals and primary care practices and are making progress in long term care in community settings. We are just really committed to making sure to spread this to scale. We started with five systems and now are in 126 systems at over 400 sites.

Provider: Can you give an example of how being out of touch affects elders when it comes to health care?

Fulmer: The principles of geriatrics relate to the fact as one gets older you have less reserve. So, if you are 35 years old and fall, your bones are fundamentally healthier than if you are 87 and you fall.

We know the principles of aging, and that is there is going to be less reserve, there is more instability, less lung reserve if you get pneumonia if you are 87 and not 35.

You [health systems, for example] have to be thinking about how you preserve function and how you will get the person back to their maximum function and their goals. This can mean that a person who has surgery or is recovering more slowly to consider, how do you get them mobilized, how do you avoid any medication problems. If a person gets pain meds when they are younger, the chances of having confusion or a side effect are much lower than if you are older.

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