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Age-Friendly Health Systems: Improving Care Quality, Safety, and Outcomes for Older Adults
Marie Cleary-Fishman, BSN, MS, MBA, CPHQ, CPPS, CHCQM
Vice President, Clinical Quality, The Center for Health Innovation, American Hospital Association
ABQAURP Diplomate and 43rd Annual Conference Faculty

Marie Cleary-Fishman, RNIn the U.S., the population of older adults with complex health care needs is growing rapidly. While the total U.S. population rose 9.7% between 2000 and 2010, the population of adults 65 and older rose 15.1%.1 One factor influencing this demographic shift is increasing life expectancy: On average, men reaching age 65 today can expect to live until age 84, and women reaching age 65 today can expect to live, on average, to age 86.2

For older adults, health care can be complicated. They are more likely to experience duplication of services, multiple transitions between care settings, harm from medications, and lack of planning that incorporates the goals of patients and their families. And according to the U.S. Department of Health and Human Services, approximately 70 percent of the 65-and-older population will need long-term care at some point in their lives.3 The U.S. health care delivery system needs to be adequately prepared to support the growing population of older adults.

4Ms Framework Addresses Older Adults’ Care Needs
This is why the John A. Hartford Foundation and Institute for Healthcare Improvement, in partnership with the AHA and Catholic Health Association of the United States, have launched the Age-Friendly Health Systems initiative. It is designed to improve patient safety and outcomes, increase patient and family engagement, and reduce the length of stay and readmissions for older adults. Participating health care organizations use an evidence-based model that focuses on the 4Ms Framework: what matters, medications, mentation and mobility.

Many care sites, including hospitals, health systems, physician clinicians, and ambulatory settings, have implemented the 4Ms Framework. Age-friendly care teams assess their current workflows to understand which processes can be eliminated or improved, with guidance from the 4Ms. These teams are using evidence-based practices to enhance quality, efficiency and the patient and family experience.

A few examples of their work and successful results:

Improved care quality and outcomes. Understanding an older adult’s health care goals is essential in developing their customized care plan, and this is achieved by asking a patient “What Matters?” Anne Arundel Medical Center (AAMC) in Annapolis, Md., incorporated "What Matters" into their care plans for older adult patients by transforming white boards into "What Matters" boards and integrating that data into electronic health records. The medical center also established age-friendly champions, who facilitate daily exercise for older patients and have improved care coordination. Through multiple interventions, including their age-friendly work, AAMC has reduced readmission rates and length of stay for older adult patients. AAMC realized that what matters to patients is to have time to do what is most important to them; by reducing hospital length of stay, readmission rates, and emergency department stays, AAMC gave cumulatively the equivalent of 10 years of time to their patients.4,5

Better value. Using evidence-based practices aligned with the 4Ms enhances quality of care and reduces the number of adverse events among older adults. This means better health outcomes for patients and reduced care costs for providers and patients. For patients with delirium, length of stay can be 20% to 30% longer than for those without delirium.6 At Hartford Hospital in Connecticut, patients with delirium stay an average of 12 days, costing $31,284, while those without delirium stay for four days, costing $8,900. Through the hospital’s Actions for Delirium Assessment Prevention and Treatment (ADAPT) program, which is integrated with the 4Ms, screening, treating and managing cases of delirium generated a $3.6 million return on a $2.4 million investment in the program.7

Better patient and family experience. The Trinity Health System, based in Livonia, Mich., has multiple sites engaged in making care more age friendly, including hospice care. Staff members found that some of the things that improve the quality of care are not clinical at all, and this is often forgotten. When one hospice patient was asked, "What matters most to you today?" it was discovered that all she wanted was an ice cream cone. Staff realized that they had a duty to make necessary changes in order to give the best care and achieve the best outcomes for their patients.

The Age-Friendly Health Systems initiative empowers teams in hospitals and other health settings to provide age-friendly care.8 One leader in this work, Denise Lyons, program manager of Christiana Care's Nurses Improving Care for Health System Elders (NICHE), explains, "We knew it was the right thing to do for our patients." This work has the potential to optimize care and value for all: patients, families, caregivers, health care providers, and the overall system.

Visit the American Hospital Association’s website for more information: https://www.aha.org/center/new-payment-and-delivery-models/age-friendly-health-systems/ .

Learn more about Age-Friendly Health Systems – Don’t Miss Marie’s session at ABQAURP’s 43rd Annual Health Care Quality and Patient Safety Conference in Clearwater Beach, FL on October 29-30, 2020. For more information and to register, visit www.abqaurp.org/AnnualConference.

[1] Werner, C. (2011). The Older Population: 2010. Census 2010 Brief. DIANE Publishing. https://www.census.gov/prod/cen2010/briefs/c2010br-09.pdf
[2] See the Social Security Administration’s Life Expectancy Calculators at www.ssa.gov/planners/lifeexpectancy.html .
[3] U.S. Department of Health and Human Services, National Clearinghouse for Long-Term Care Information, www.longtermcare.gov/the-basics (accessed September 2016).
[4] Creating Age-Friendly Health Systems. (August 2019). Accessed at https://www.aha.org/system/files/2018-08/age-friendly-v17.pdf.
[5] Deploying the 4Ms to Improve Outcomes and Health Experiences for Older Adults. (2018). Huddle for Care. Accessed at https://www.huddleforcare.org/story/deploying-the-4ms-to-improve-outcomes-and-health-experiences-for-older-adults/.
[6] Cheney, Christopher. (May 2019). Improve Health of Seniors with 4-pronged, Age-friendly Strategy. Accessed at https://www.healthleadersmedia.com/clinical-care/improve-health-seniors-4-pronged-age-friendly-strategy .
[7] Ibid
[8] Building an Age-friendly Health Care System. Accessed at https://trustees.aha.org/newdeliverymodels/articles/building-an-age-friendly-health-care-system.