The 4Ms of an Age-Friendly Health System

Emery-Tiburcio, Erin; Mack, Laurin; Zonsius, Mary C.; Carbonell, E.; Newman, Michelle

doi:10.1097/01.naj.0000799016.07144.0d

Cited by 24 publications

(30 citation statements)

References 14 publications

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“…Aspects, such as being accepted and treated as a valued person, being involved in their own care and conversations, and receiving personalized and tailored care, are described in these studies and seem to be important for this patient group [ 16 , 58 , 60 , 61 ]. In contrast to current initiatives for an age-friendly health system such as the 4Ms framework (What Matters, Medication, Mentation and Mobility) [ 62 ], which, among other things, considers the mentation of older people, the characteristics of a DFH we identified seem to address the needs of people with dementia more specifically and comprehensively.…”

Section: Discussionmentioning

confidence: 76%

Characteristics of dementia-friendly hospitals: an integrative review

et al. 2022

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Background/Objectives Dementia-friendly initiatives are becoming common in society, politics, and research, including health care. Regarding efforts to improve care for patients with dementia in hospitals, the term dementia-friendly hospital is being used increasingly. However, a theoretical understanding of this term and the underlying concept are missing. This integrative review aims to identify current descriptions of dementia-friendly hospitals and to analyze their characteristics. Methods An integrative review was conducted. The databases MEDLINE, CINAHL, PsycInfo, Cochrane Library, and additional resources were searched. Two reviewers independently screened publications for inclusion. We extracted data from the included publications and analyzed the descriptions of dementia-friendly hospitals using inductive content analysis in an iterative process. Results We identified 4191 records and included 34 publications on 17 descriptions of dementia-friendly hospitals. These were found in the context of practice projects (n = 8), recommendations (n = 6) and research (n = 3). Our analysis resulted in six characteristics of dementia-friendly hospitals. Characteristics related to the patients and their care are continuity, person-centeredness, consideration of phenomena within dementia and environment. Additional characteristics are valuing relatives and knowledge and expertise within the hospital. Conclusion Dementia-friendly hospitals are currently characterized more by healthcare practices and professional dementia experts than by the results of empirical studies. Additionally, the perspective of people with dementia is underrepresented in current descriptions. Accordingly, further research is needed that involves people with dementia in order to develop a theoretical understanding and suitable concepts of dementia-friendly hospitals, since their perspective is essential.

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Section: Discussionmentioning

confidence: 76%

Characteristics of dementia-friendly hospitals: an integrative review

et al. 2022

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“…Whereas disease-focused outcomes are most commonly evaluated in RCTs, a more comprehensive assessment of goals, patient-reported outcomes, and preferences that include physical, psychological, cognitive, and functional domains are important to consider with medications that are used in routine practice for older adults. These tenets to prescribing align with the geriatric principles of the 4Ms, a set of four evidence-based elements of high-quality care in older adults, consisting of what Matters most, Medication, Mentation, and Mobility (23). Multicomplexity was later added to create the consolidated framework known as the Geriatric 5Ms that helps ensure older adults receive the best care possible, are not harmed by health care, and are satisfied with the care they receive (24).…”

Section: Introductionmentioning

confidence: 99%

Optimizing Medication Use in Older Adults With Rheumatic Musculoskeletal Diseases: Deprescribing as an Approach When Less May Be More

Lee

Singh

Gray

et al. 2022

ACR Open Rheumatology

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The world population is aging, and the rheumatology workforce must be prepared to care for medically complex older adults. We can learn from our colleagues and experts in geriatrics about how to best manage multimorbidity, polypharmacy, geriatric syndromes, and shifting priorities of older adults in the context of delivering care for rheumatic and musculoskeletal diseases (RMDs). Polypharmacy, a common occurrence in an aging population with multimorbidity, affects half of older adults with RMDs and is associated with increased risk of morbidity and mortality. In addition, potentially inappropriate medications that should be avoided under most circumstances is common in the RMD population. In recent years, deprescribing, known as the process of tapering, stopping, discontinuing, or withdrawing drugs, has been introduced as an approach to improve appropriate medication use among older adults and the outcomes that are important to them. As the rheumatology patient population ages globally, it is imperative to understand the burden of polypharmacy and the potential of deprescribing to improve medication use in older adults with RMDs. We encourage the rheumatology community to implement geriatric principles, when possible, as we move toward becoming an age‐friendly health care specialty.

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“…[9] For decades, there has been growing interest in mitigating the harmful effects of polypharmacy. Where earlier work has been focused on reducing polypharmacy and discontinuing medications where harm outweighs bene ts, recent efforts have considered "deprescribing", a process which considers a more holistic approach of medication safety which is aligned with the 4Ms of Age-Friendly care 4Ms (mind, mobility, medications, and what matters most) [10]. Although de nitions vary, deprescribing is the process of discontinuing, or reducing the dose of, medications that are no longer needed, or where risks outweigh bene ts or are inconsistent with goals of care.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Deprescribing Interventions in Older Adults: An Overview of Systematic Reviews

Chua

Todd

Reeve

et al. 2022

Preprint

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Background: Rigorous evidence to guide deprescribing is limited, and priorities to inform deprescribing research and practice remain unclear. The objective of this overview of systematic reviews (i.e. reviews) was to synthesize the available review evidence regarding the effectiveness of interventions to deprescribe medications in older adults. Methods 11 databases were searched from January 2005 to October 2020. We included randomized or non-randomized controlled designs. Two independent reviewers screened and extracted data. We synthesized results in two steps: Step 1 identified results as reported by the original review (including meta-analyses) and Step 2 involved a narrative synthesis of reviews by outcome. Pre-specified subgroups included patient characteristics (e.g., dementia, frailty, advanced age), intervention type and setting. Outcomes included medication-related outcomes (e.g., medication reduction, potentially inappropriate medications) or other outcomes(e.g., mortality, adverse effects, falls, cognition, hospitalizations, quality of life, costs, surrogate biomarkers). Assessment of Multiple Systematic Reviews 2 was used to assess quality of reviews. RESULTS: 2,335 unique citations were retrieved, of which 93 full-text articles were assessed for eligibility. 33 reviews (encompassing 13 meta-analyses) were included. 19 of the 33 reviews had a general deprescribing focus, 13 focused on specific medication classes or therapeutic category and one review included both. Ten of 13 reviews meta-analyzed medication-related outcomes (29 outcomes: 21 favored the intervention, seven reported no difference and one favored the comparison). The narrative synthesis indicated that most interventions resulted in some evidence of medication reduction. Few meta-analyses reported on other outcomes, and our narrative synthesis found primarily mixed effects or no evidence of an effect on these outcomes. Limited information was available for patient characteristic subgroups. All reviews scored low or critically low on quality assessment. CONCLUSIONS: Deprescribing interventions likely resulted in medication reduction. Information about other outcomes was not routinely examined, and where included, studies were likely underpowered. The evidence, though of low quality, suggests deprescribing was not associated with increased adverse events, and had little evidence of effect on mortality, quality of life and health-care use. Future research should focus on designing studies powered to examine harms, patient-centered outcomes and the effects on vulnerable subgroups. Systematic Review Registration PROSPERO CRD42020178860 This study was supported by NIA (1R24AG064025).

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The 4Ms of an Age-Friendly Health System

Cited by 24 publications

References 14 publications

Characteristics of dementia-friendly hospitals: an integrative review

Characteristics of dementia-friendly hospitals: an integrative review

Optimizing Medication Use in Older Adults With Rheumatic Musculoskeletal Diseases: Deprescribing as an Approach When Less May Be More

Effectiveness of Deprescribing Interventions in Older Adults: An Overview of Systematic Reviews

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