Leadership Corner: Age-Friendly Health Systems Are Needed Now More Than Ever

MHA Keystone Center Leadership Corner

The Leadership Corner features updates from the MHA leadership team. The updates will provide new insights to safety and quality, as well as updates on MHA Keystone Center activities and initiatives.

Ewa Panetta, BA, CPPS, manager of safety and quality, MHA Keystone CenterEwa Panetta, BA, CPPS, manager of safety and quality, MHA Keystone Center, discusses the MHA Keystone Center Age-Friendly Health Systems Action Community and the importance of equipping hospitals to provide age-friendly care during a pandemic. 

The impact of the 2019 Novel Coronavirus (COVID-19) pandemic on healthcare systems has been profound as organizations adjust to a continually evolving environment. Nevertheless, healthcare employees continue to perform remarkable work in the face of many unknowns.

One key lesson has surfaced during this pandemic – the urgent need for age-friendly healthcare. Older adults and individuals with underlying, serious medical conditions are at higher risk for morbidity and mortality related to COVID-19. Addressing this issue has been a priority for the MHA Keystone Center Age-Friendly Health Systems Action Community, which focuses on reliably implementing geriatric care consistent with evidence-based best practices.

Funded by the Michigan Health Endowment Fund, the MHA Keystone Center Age-Friendly Health Systems Action Community models the successful Age-Friendly Health Systems movement launched by the John A. Harford Foundation and Institute for Healthcare Improvement (IHI), in partnership with the American Hospital Association and Catholic Health Association of the United States in 2017. The initiative focuses on adults 65 years and older by concentrating on the 4Ms Framework for creating age-friendly environments.

  • What Matters to the patient/family.
  • Medication – using age-friendly medications that don’t interfere with Mobility, Mentation or What Matters.
  • Mentation – preventing, identifying and treating conditions like dementia, depression and delirium appropriately.
  • Mobility – ensuring older adults move safely every day to maintain and improve function.

4Ms Framework graphic of an age friendly health system

These essential elements ensure that older adults receive optimal care across healthcare settings, experience no healthcare-related harms and that the care they receive aligns with What Matters the most to them and their caregivers. The initiative is designed for hospital-based teams (emergency departments, ICUs, general wards and medical-surgical units) and ambulatory care teams (primary care and specialty care).

The MHA Keystone Center launched its first cohort of the Age-Friendly Health Systems Action Community in October 2019. During the seven-month Action Community, teams focus on assessing and implementing the 4Ms elements. Participating organizations are eligible to receive two levels of recognition by the IHI:

  • Age-Friendly Health System Participants are recognized for being on the journey to becoming an Age-Friendly Health System and have submitted a description of how they are putting the 4Ms into practice.
  • Committed to Care Excellence as an Age-Friendly Health System is recognition for exemplars in the movement. Organizations that receive this recognition demonstrate profound alignment with the elements of the 4Ms Framework.

Of the 20 participating sites, three organizations – Sparrow Ionia Hospital, TONE Home Health, and Bronson LakeView Hospital – have been recognized by the IHI as Age-Friendly Health Systems

The MHA Keystone Center acknowledges these efforts and encourages the sustainability of age-friendly care.

The MHA Keystone Center Age-Friendly Health Systems Action Community has adjusted its timeline, needs and priorities during the COVID-19 pandemic to better serve participating sites. Despite these circumstances, participants continue to reach the Age-Friendly Health Systems recognition levels.

Lessons Learned During the COVID-19 Pandemic

The COVID-19 pandemic has increased awareness and the need for Age-Friendly Health Systems. By becoming an Age-Friendly Health System, hospitals and healthcare practices are well-equipped to support older patients at a higher risk of severe illness.

What Matters: To provide high-quality and safe care, clinicians should understand and actively support What Matters to the patient. Conversations about advance care plans and goals of care are the essential first steps in care planning. Healthcare clinicians are encouraged to use telehealth channels to ask patients their goals, preferences and priorities. They can work together to build a care plan focusing on physical distancing and ensuring they have all their basic needs met, such as access to food or medication.

Medication: The 4Ms Framework enhances facilities’ focus on reviewing and deprescribing high-risk medications. If medication is necessary, the use of age-friendly medication that does not interfere with What Matters to the older adult, Mobility, or Mentation is encouraged. The COVID-19 pandemic presents medication management challenges for older adults. Older adults may experience barriers to managing their medication at home or receiving medication, as many stay home per federal and state guidelines.

Mentation: While isolating at home, older adults are at a higher risk for developing mentation issues like depression and delirium. The 4Ms Framework assists healthcare clinicians in prioritizing and putting key strategies in place to help prevent, identify, treat and manage depression, dementia and delirium across the care continuum.

Mobility: With limited opportunities to move around, older adults may experience a decline in function leading to a negative long-term impact. The Age-Friendly Health Systems movement addresses this element by providing support for clinicians to ensure they work with older adults to find safe alternatives to moving around safely every day.

The MHA Keystone Center Age-Friendly Action Community continues to serve as a supportive community for healthcare teams working to provide evidence-based care to older adults while lowering care costs. The MHA Keystone Center is exploring opportunities to continue the Age-Friendly Health System movement in the future.

Please view the MHA website for additional MHA Keystone Center quality improvement projects and future cohorts of the Age-Friendly Health Systems Action Community.