Age-Friendly Care Guided by National 4Ms Model Initiative at Hackensack University Medical Center

Approach Helps Hospitals and Patients Assess and Manage Medications, Outcome Goals, Memory Issues and Mobility

Because many older adults suffer from more than one chronic disease and take multiple medications, care management can get overwhelming. To help health care providers better communicate with and serve the geriatric population, Hackensack University Medical Center is applying the 4Ms framework as a participant of Age-Friendly Health Systems.

Age-Friendly Health Systems is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) in partnership with the American Hospital Association and the Catholic Health Association of the United States (CHA). The initiative’s goal is to rapidly spread the 4Ms framework to 20% of U.S. hospitals and medical practices by 2020.

The 4Ms include:

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

Medication: If medications are necessary, use age-friendly medications that do not interfere with What Matters, Mentation or Mobility. The center has a robust high-risk medication use identification, stop and education program for clinicians as part of The Joint Commission Geriatrics-Delirium DSC certification held since 2011.

Mentation: Prevent, identify, treat and manage depression, dementia and delirium across settings of care. Hackensack University Medical Center screens all patients 65 and older for cognition using Mini-cog and delirium using the Confusion Assessment Method. Additionally, senior patients benefit from the Hospital Elder Life Program (HELP), an evidence-based delirium prevention program designed to improve the all-around hospital experience of older patients. Delirium education is included in the staff on boarding process and annual nursing education hospital-wide. In 2018 the center launched a delirium prevention bundle on the med-surge unit, and is in the process of expanding it to the trauma step-down unit.

Mobility: Ensure that older adults move safely every day to maintain function and do What Matters. Hackensack University Medical Center has had a nursing-driven bedside mobility protocol since 2016 and has recently incorporated the Johns Hopkins Mobility Program in the med-surge unit and other areas.

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