Evidence for the 4Ms: Interactions and Outcomes across the Care Continuum

Abstract

Objectives: An expert panel reviewed and summarized the literature related to the evidence for the 4Ms—what matters, medication, mentation, and mobility—in supporting care for older adults. Methods: In 2017, geriatric experts and health system executives collaborated with the Institute for Healthcare Improvement (IHI) to develop the 4Ms framework. Through a strategic search of the IHI database and recent literature, evidence was compiled in support of the framework’s positive clinical outcomes. Results: Asking what matters from the outset of care planning improved both psychological and physiological health statuses. Using screening protocols such as the Beers’ criteria inhibited overprescribing. Mentation strategies aided in prevention and treatment. Fall risk and physical function assessment with early goals and safe environments allowed for safe mobility. Discussion: Through a framework that reduces cognitive load of providers and improves the reliability of evidence-based care for older adults, all clinicians and healthcare workers can engage in age-friendly care.

The Urgent Need for Rigorous Studies of Telehealth for Older Adults Who Are Homebound

“…The study by Wong et al2 may have reduced the barrier to entry into telehealth by using telephone-based technology such as text messaging, which is more accessible to patients with low digital literacy. Investment in technological interfaces that are accessible and easy to use is critical to expanding access to telehealth among older adults who are homebound.Future research in telehealth for older adults who are homebound should focus on how telehealth can enhance care around the age-friendly domains of mobility, mentation, medications, and what matters most, for which many evidence-based interventions for geriatric care urgently await study and validation in the telehealth sphere 7. Although the study by Wong et al 2 focuses on telehealth care's potential to improve medication adherence and mood among older adults who are homebound, future randomized clinical trials should investigate telehealth interventions to maximize mobility as well as align care with what matters most to each older person who is homebound.As the COVID-19 pandemic continues to restrict the abilities of older adults who are homebound to access the medical and psychosocial care they need, randomized clinical trials such as the study by Wong et al 2 demonstrate a path forward to expand clinical care delivery and unlock the potential of innovative telehealth modalities.…”

The 5Ms of Geriatrics in Gastroenterology: The Path to Creating Age-Friendly Care for Older Adults With Inflammatory Bowel Diseases and Cirrhosis

“… Mind refers to mood and memory—to prevent, identify early, treat, and manage conditions such as depression, delirium, and dementia. This acknowledges that there are many modifiable risk factors for cognitive decline in older adults ( 23 ). Mobility is to ensure an appropriate approach to assist and encourage older adults to move safely and maintain functional ability to perform activities of daily living and beyond ( 24 ).…”

“… Multicomplexity is in recognition of the significant burden of multiple comorbidities, geriatric syndromes, and serious illness prevalent in older adults and to assess conditions affected by age and social concerns, such as financial vulnerability and social isolation ( 25 ). Matters most is a reminder to provide patient-centered care to prioritize older adults' specific health outcome goals and care preferences tailored to their overall health and life ( 23 ). …”

Changing the dynamic: What can we learn from infectious disease management in long-term care settings?

“…Without such a guiding framework and standardized, fundamental practices, long term care teams may be left without ways to cope with new challenges affecting a large number of residents and staff members. 4 …”