What Does Age-Friendly Care Look Like?
Updated: 4 days ago
For many people, a visit to the doctor is fairly straightforward.
You have a health concern, your doctor asks questions and performs an exam or tests, and together you decide on a treatment plan.
But healthcare can become more complicated as we get older.
Managing chronic conditions, taking multiple medications, seeing different doctors and specialists, and balancing medical care with the things that matter most in everyday life can make it harder to know what to discuss during a doctor's visit.
This is where the 4Ms of age-friendly care can help.
Promoted by organizations such as the American Medical Association, the 4Ms provide a framework for making healthcare more responsive to the needs and priorities of older adults.
4Ms stand for What Matters, Medication, Mentation, and Mobility.
Let's go through each one.
1. What Matters
Healthcare is not just about treating a medical condition. It is also about helping you live the life that matters to you.
For one person, that might mean staying independent at home.
For another, it could mean having enough energy to attend a grandchild's graduation, continue a favorite hobby, or remain able to care for a spouse.
Letting your doctor know about these priorities can help your care team understand what you want your treatment to accomplish.
For example, an older adult may say that being able to garden is one of the things that gives them the most enjoyment.
If knee pain is making gardening difficult, the conversation doesn't have to focus only on reducing pain. The doctor can also understand the patient's larger goal which is being able to get outside and garden. That may help guide discussions about physical therapy, medications, mobility aids, or other treatments.
Before an appointment, consider writing down:
What is most important to you right now?
What activities do you want to continue doing?
Are there things you are worried you may no longer be able to do?
What would make a treatment plan difficult for you or your caregiver to follow?
Your answers can help your doctor create a plan that fits your life not just your diagnosis.
2. Medication
Medications can play an important role in managing health conditions. But as the number of medications increases, so does the need to make sure they are still safe and necessary.
About four in 10 older adults take five or more prescription medications. Taking multiple medications can make it harder to keep track of them and can increase the possibility of side effects or interactions between medications.
During a medication review, your healthcare team may consider questions such as:
Is each medication still necessary?
Are any medications causing side effects?
Could two medications interact with each other?
Are there medications that could be reduced or stopped?
Are the medications being taken as prescribed?
Older adults and caregivers can make this process easier by keeping an up-to-date medication list.
Include prescription medications, over-the-counter medications, vitamins, and supplements. Note the dose and how often each medication is taken.
If a medication has been stopped, make a note of that as well.
It can also be helpful to write down any new or unusual symptoms that appear after starting a medication.
Bring the list to medical appointments and update it whenever a medication is started, stopped, or changed.
3. Mentation
Mentation refers to thinking, memory, and mental function.
Changes in these areas can sometimes be easy to miss, particularly when an older adult is seeing multiple healthcare providers.
One important change to watch for is a sudden change in attention or thinking, particularly during an illness or after hospitalization.
For example, someone who normally manages their bills without difficulty may suddenly become confused or unable to complete familiar tasks.
A sudden change in mental status can be a sign of a medical problem and should be brought to a healthcare professional's attention promptly.
Other changes in memory or thinking may develop more gradually. These can have many possible causes, including medication effects, depression, sleep problems, or conditions that affect memory and thinking.
This is one area where caregivers and family members can play an especially important role.
Because they often know an older adult's usual routines and abilities, they may notice changes that the person or healthcare team does not immediately recognize.
If you notice a change in someone's memory, thinking, mood, behavior, or ability to perform familiar activities, tell their healthcare provider what you have observed and when it began.
Keeping notes about changes can also help. Instead of simply saying, "Mom seems confused," it can be more useful to explain what changed. For example, "She normally manages her medications independently, but for the past week she has been forgetting which pills to take."
4. Mobility
Being able to move safely and independently can have a major impact on an older adult's health and quality of life.
Mobility can become more difficult because of changes in muscle strength, balance, chronic health conditions, pain, injuries, or falls.
Tell your healthcare provider if you or a loved one:
Has fallen recently
Feels unsteady when walking
Has difficulty getting out of a chair or bed
Has become less active
Needs help walking or completing everyday activities
Has started using a cane, walker, or other mobility aid
Is afraid of falling
These details can help your healthcare team identify ways to improve safety and maintain independence.
Depending on the situation, your doctor may recommend things such as physical therapy, an evaluation of medications that could affect balance, exercises to improve strength, or other strategies to reduce the risk of falls.
Putting the 4Ms Into Practice
For doctors, keeping the 4Ms in mind can help ensure that care is tailored not only to an older adult's medical needs, but also to their goals, abilities, and everyday circumstances.
Doctors should be proactive in asking about a patient's goals, medications, changes in thinking or mood, and mobility.
For older adults and their caregivers, the 4Ms can serve as a reminder to be observant and speak up.
Pay attention to changes in medications, thinking, mobility, and daily activities, and share those observations with the healthcare team.
Let the doctor know what matters most to the older adult, what concerns they have, and what changes they have noticed.
The more information doctors have about an older adult's health and daily life, the better they can work with patients and caregivers to develop a care plan that fits the person and not just the condition.
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