Age-Friendly Health System Research Articles

Feasibility of the Age-Friendly Health System in Acute Cardiac Care Units for Delirium Detection and Management

Background Optimal delirium care requires a multicomponent approach. However, implementation of such comprehensive care in a fast-paced specialized unit like acute cardiac care unit is challenging. The Age-Friendly Health System (AFHS) 4Ms initiative focuses on four key components, What Matters, Medication, Mentation, and Mobility, and provides a simple but comprehensive framework for optimal delirium care. However, studies reporting the application of AFHS 4Ms focusing on delirium care are lacking. Objective We aimed to evaluate the feasibility of the AFHS 4Ms on delirium detection and management among older adults in acute cardiac care units. Methods We conducted a quality improvement (QI) project using the AFHS 4Ms framework and implemented specific strategies for each M in the acute cardiac care units at a tertiary teaching hospital. Then, we assessed the changes in the rates of delirium screening and the rates of positive screening results during the QI project period using Cochran-Armitage test, and compared the percentages of older adults who received delirium-related orders before and after the initiative using Fisher’s exact test. Results The overall rate of delirium screening was 79.5% (68.3% in August, 81.0% in September, 87.2% in October, 87.9% in November, and 72.9% in December). The overall rate of positive delirium screening results was 9.3% (6.3% in August, 10.8% in September, 8.5% in October, 6.0% in November, and 5.0% in December). The utilization of all of the delirium-related orders was reduced, 2.4% to 1.9% for haloperidol, 6.9% to 5.1% for lorazepam, 6.5% to 3.0% for a physical restraint order, and 4.1% to 2.6% for a sitter order, before and after the initiative. However, all of the decreasing trends were not statistically significant. Conclusion We showed that it is feasible to apply AFHS 4Ms for delirium detection and management in acute cardiac care units. Future prospective studies are needed.

Guiding Post-Hospital Recovery by 'What Matters:' Implementation of Patient Priorities Identification in a VA Community Living Center.

Patient priorities care (PPC) is an effective age-friendly health systems (AFHS) approach to aligning care with goals derived from 'what matters'. The purpose of this quality improvement program was to evaluate the fidelity and feasibility of the health priorities identification (HPI) process in VA Community Living Centers (CLC). PPC experts worked with local CLC staff to guide the integration of HPI into the CLC and utilized a Plan-Do-Study-Act (PDSA) model for this quality improvement project. PPC experts reviewed health priorities identification (HPI) encounters and interdisciplinary team (IDT) meetings for fidelity to the HPI process of PPC. Qualitative interviews with local CLC staff determined the appropriateness of the health priorities identification process in the CLC. Over 8 months, nine facilitators completed twenty HPI encounters. Development of a Patient Health Priorities note template, staff education and PPC facilitator training improved fidelity and documentation of HPI encounters in the electronic health record. Facilitator interviews suggested that PPC is appropriate in this setting, not burdensome to staff and fostered a person-centered approach to AFHS. The HPI process is an acceptable and feasible approach to ask the 'what matters' component of AFHS in a CLC setting.

Longitudinal Assessment of Mobility and Self-care Among Critically Ill Older Adults. An Age-Friendly Health Systems Initiative Quality Improvement Study.

Early mobility in the intensive care unit (ICU) is vital to maintaining an older adult patient's performance of activities of daily living, functional mobility, and overall quality of life. Prior studies have shown reduced length of inpatient stay and onset of delirium in patients with early mobilization. Despite these benefits, many ICU patients are often labeled as too sick to participate in therapy and frequently do not receive physical (PT) or occupational therapy (OT) consults until they are considered floor status. This delay in therapy can negatively affect a patient's capacity to participate in his/her self-care, add to the burden on caregivers, and limit disposition options. Our goals were to perform a longitudinal assessment of mobility and self-care among older patients through their medical ICU (MICU) stays and to quantify visits by therapy services to identify areas for improvement in achieving early intervention in this at-risk population. This was a retrospective quality improvement analysis of a cohort of admissions to the MICU at a large tertiary academic medical center between November 2018 and May 2019. Admission information, PT and OT consult information, Perme Intensive Care Unit Mobility Score, and Modified Barthel Index scores were entered into a quality improvement registry. Inclusion criteria consisted of age older than 65 years and at least 2 distinct visits by PT and/or OT for evaluation. Patients without consults and patients with weekend-only MICU stays were not assessed. There were 302 MICU patients 65 years or older admitted during the study period. Forty-four percent (132) of these patients received PT/OT consults, and among these, 32% (42) had at least 2 visits to allow comparison of objective scores. Seventy-five percent of patients had improved Perme scores (median, 9.4%; interquartile range, 2.3%-15.6%), and 58% of patients had improved Modified Barthel Index scores (median, 3%; interquartile range, -2% to 13.5%). However, 17% of potential therapy days were missed because of inadequate staffing/time, and 14% were missed because of being sedated or unable to participate. In our cohort of patients older than 65 years, receipt of therapy in the MICU led to modest improvements in score-assessed mobility and self-care before transfer to floor. Staffing, time constraints, and patient sedation or encephalopathy appeared to interfere most with further potential benefits. In the next phase, we plan to implement strategies to increase PT/OT availability in the MICU and implement a protocol to increase identification and referral of candidates for whom early therapy can prevent loss of mobility and ability to perform self-care.

Integrating 4Ms Assessment through Medicare Annual Wellness Visits: Comparison of Quality Improvement Strategies in Primary Care Clinics.

The Medicare Annual Wellness Visit (AWV), which includes comprehensive preventative assessments and screenings, is associated with improved preventative services, including vaccination and cancer screenings. However, the AWV alone does not promote whole-person care. Integrating the AWV within an Age-Friendly Health System (AFHS) contextualizes AWV services within a comprehensive geriatric care framework that integrates the "4Ms" (mentation, medication, mobility, and what matters). This study describes and evaluates quality improvement initiatives to improve the completion of AWV within two different AFHS-recognized health systems (an academic university clinic and a Federally Qualified Health Center). The results from this evaluation present opportunities that other health systems can consider for leveraging electronic health records (EHRs) and enabling services to complete AWVs within a 4Ms framework. The implementation results also suggest an adaptation of the 4Ms assessment schedule for patients with complex chronic conditions who may suffer from multiple comorbidities and cognitive impairment.

Peer-to-Patient-Aligned Care Team (Peer-to-PACT; P2P), a Peer-Led Home Visit Intervention Program for Targeting and Improving Long-term Care Services and Support for Veterans With High Needs and High Risk: Protocol for a Mixed Methods Feasibility Study.

Keeping older veterans with high needs and high risk (HNHR) who are at risk of long-term institutional care safely in their homes for as long as possible is a Department of Veterans Affairs priority. Older veterans with HNHR face disproportionate barriers and disparities to engaging in their care, including accessing care and services. Veterans with HNHR often have poor ability to maintain health owing to complicated unmet health and social needs. The use of peer support specialists (peers) is a promising approach to improving patient engagement and addressing unmet needs. The Peer-to-Patient-Aligned Care Team (Peer-to-PACT; P2P) intervention is a multicomponential home visit intervention designed to support older veterans with HNHR to age in place. Participants receive a peer-led home visit to identify unmet needs and home safety risks aligned with the age-friendly health system model; care coordination, health care system navigation, and linking to needed services and resources in collaboration with their PACT; and patient empowerment and coaching using Department of Veterans Affairs whole health principles. The primary aim of this study is to evaluate the preliminary effect of the P2P intervention on patient health care engagement. The second aim is to identify the number and types of needs and unmet needs as well as needs addressed using the P2P needs identification tool. The third aim is to evaluate the feasibility and acceptability of the P2P intervention delivered over 6 months. We will use a quantitative-qualitative convergent mixed methods approach to evaluate the P2P intervention outcomes. For our primary outcome, we will conduct an independent, 2-tailed, 2-sample t test to compare the means of the 6-month pre-post differences in the number of outpatient PACT encounters between the intervention and matched comparison groups. Qualitative data analysis will follow a structured rapid approach using deductive coding as well as the Consolidated Framework for Implementation Research. Study enrollment began in July 2020 and was completed in March 2022. Our sample size consists of 114 veterans: 38 (33.3%) P2P intervention participants and 76 (66.7%) matched comparison group participants. Study findings are expected to be published in late 2023. Peers may help bridge the gap between PACT providers and veterans with HNHR by evaluating veterans' needs outside of the clinic, summarizing identified unmet needs, and developing team-based solutions in partnership with the PACT. The home visit component of the intervention provides eyes in the home and may be a promising and innovative tool to improve patient engagement. DERR1-10.2196/46156.

More of a Good Thing: A Framework to Grow and Strengthen the PALTC Careforce

The current staffing shortage across all disciplines of post-acute and long-term care (PALTC) settings is affecting the health and safety of residents, as well as the well-being of the current staff. The need to retain and recruit new talent to this challenging but fulfilling setting demands that we look to existing evidence-based strategies and identify ways to implement them quickly, effectively, and in a sustainable way. Using the 4 Ms Framework of the Age-Friendly Health System developed by the Institute for Healthcare Improvement and the John A. Hartford Foundation (What Matters, Medication, Mentation, and Mobility), we can build on successful strategies to address what matters to staff, mental health, career mobility, and the overall safety and wellness of our nation's careforce. This paper summarizes “More of a Good Thing: A Framework to Grow and Strengthen the PALTC Careforce,” a series of 6 roundtable discussions held in 2022 that brought together clinicians, industry leaders, and change-makers to share strategies that have been researched and successfully implemented and discuss ways to scale and disseminate them to a broader audience. The role of PALTC leadership is highlighted, with key points from the final roundtable discussion outlined, and challenging leadership to think about what they can begin doing immediately to build trust with existing staff and lay the foundation for a stronger nursing home careforce. Next steps for “More of a Good Thing” include a survey of participants about what they have tried, what has been successful, and what barriers they face; a series of focused interviews with leaders; and potential collaboration with quality improvement organizations to help facilities build on and implement the strategies presented.

Clinical benefit (rate) of geriatric assessment in a Veterans Affairs (VA)-based oncology clinic according to the Geriatric 5Ms framework.

e24010 Background: The geriatric assessment (GA) is a validated, multi-system assessment tool that can detect vulnerabilities often not captured with standard oncology assessments in older adult patients with cancer. The Geriatric 5Ms is a novel communication framework used to describe core competencies in geriatrics. Prior studies have shown GA integration in oncology practice can significantly reduce grade 3 or higher chemotherapy-related toxicities, falls, polypharmacy, hospital length of stay (LOS), increase completion of advanced directives, and improve quality of life measures. Despite these benefits, implementation into clinical practice has remained low. This study aimed to utilize telemedicine to integrate GA into a busy VA oncology practice. Methods: In this quality improvement study design, we enrolled adult patients aged 70 years and older with solid tumors or hematologic malignancy, either newly established or receiving active systemic treatment through an urban, academic VA oncology clinic. Patients were assigned to the intervention (GA conducted via telemedicine by a geriatric specialist) if they scored ≤14 on G8, a validated screening tool. Outcomes were compared with a historical control cohort who received usual care (no virtual GA). Reported here are the clinical benefits measured qualitatively according to the geriatric 5Ms framework. Results: Between January 1, 2022 and March 30, 2022, we enrolled 116 patients (n = 57 intervention, 59 control) from a US VA-based population. Patients had a mean age of 76.8 (SD 6.2) between both cohorts and all patients were male (100%). Among patients in the intervention cohort, all patients (100%) derived benefit in at least one element of the 5M’s framework (Mind, Mobility, Medications, Multicomplexity, and Matters Most) from GA. Based on findings from the GA, services were provided in each of the 5M’s categories in the following frequencies: multicomplexity (88%), matters most (71%), medication (58%), mentation (50%), and mobility (46%). Conclusions: Incorporating GA via telemedicine into routine oncologic care was feasible within this VA-based population of older adult patients with cancer. Further, this project led to clinic recognition as an Age Friendly Health System by the Institute for Healthcare Improvement (IHI). When routinely performed, geriatric assessment led to clinical benefit among all patients receiving the intervention according to the 5M’s framework. Future studies will compare the clinical benefits of this intervention to clinical outcomes measures such as hospital length of stay, emergency room utilization, therapy toxicity, and survival among this patient population.

Study protocol: Type III hybrid effectiveness-implementation study implementing Age-Friendly evidence-based practices in the VA to improve outcomes in older adults

BackgroundUnmet care needs among older adults accelerate cognitive and functional decline and increase medical harms, leading to poorer quality of life, more frequent hospitalizations, and premature nursing home admission. The Department of Veterans Affairs (VA) is invested in becoming an “Age-Friendly Health System” to better address four tenets associated with reduced harm and improved outcomes among the 4 million Veterans aged 65 and over receiving VA care. These four tenets focus on “4Ms” that are fundamental to the care of older adults, including (1) what Matters (ensuring that care is consistent with each person’s goals and preferences); (2) Medications (only using necessary medications and ensuring that they do not interfere with what matters, mobility, or mentation); (3) Mentation (preventing, identifying, treating, and managing dementia, depression, and delirium); and (4) Mobility (promoting safe movement to maintain function and independence). The Safer Aging through Geriatrics-Informed Evidence-Based Practices (SAGE) Quality Enhancement Research Initiative (QUERI) seeks to implement four evidence-based practices (EBPs) that have shown efficacy in addressing these core tenets of an “Age-Friendly Health System,” leading to reduced harm and improved outcomes in older adults.MethodsWe will implement four EBPs in 9 VA medical centers and associated outpatient clinics using a type III hybrid effectiveness-implementation stepped-wedge trial design. We selected four EBPs that align with Age-Friendly Health System principles: Surgical Pause, EMPOWER (Eliminating Medications Through Patient Ownership of End Results), TAP (Tailored Activities Program), and CAPABLE (Community Aging in Place – Advancing Better Living for Elders). Guided by the Pragmatic Robust Implementation and Sustainability Model (PRISM), we are comparing implementation as usual vs. active facilitation. Reach is our primary implementation outcome, while “facility-free days” is our primary effectiveness outcome across evidence-based practice interventions.DiscussionTo our knowledge, this is the first large-scale randomized effort to implement “Age-Friendly” aligned evidence-based practices. Understanding the barriers and facilitators to implementing these evidence-based practices is essential to successfully help shift current healthcare systems to become Age-Friendly. Effective implementation of this project will improve the care and outcomes of older Veterans and help them age safely within their communities.Trial registrationRegistered 05 May 2021, at ISRCTN #60,657,985.Reporting guidelinesStandards for Reporting Implementation Studies (see attached).

Postgraduate dental resident education: A pilot in age-friendly "mentation" training.

Postdoctoral dental education in caring for older adults lacks didactic and clinical training in mentation topics, one of the core elements of the Age-Friendly Health Systems (AFHS) framework. Our primary goal was to launch a pilot project in clinical geriatrics focusing on older adults' mentation concerns, with a secondary goal to improve dental residents' confidence and competence in dental care and oral health. Age-friendly care elements are not routinely incorporated into the dental education of residents caring for older adults with cognitive impairment or dementia. Therefore, we implemented a pilot educational project, providing the missing educational opportunity for residents in geriatric training covering cognitive impairment and focusing on Alzheimer's disease and related dementias. We designed educational sessions through a needs assessment, focus group discussions, and expert validation. We developed three e-Learning modules covering mentation concerns and dementia screening. We tested the modules in a pilot study of 15 dental postdoctoral residents as an essential part of their clinical practice. The dementia dental learning module increased the residents' satisfaction with didactic preparedness (4.45 0.97) and knowledge acquisition (4.36 0.84). Residents strongly believed that learning about the AFHS-mentation topic would improve patient care. Our pilot study is a pioneer project in support of a new AFHS-themed dental curriculum for clinical education. Further expansion of the age-friendly principles to include mobility, medications, and what matters to older adults will establish a model framework of redesigned geriatric dental education for academic centers.

Optimizing Medications with the Geriatrics 5Ms: An Age-Friendly Approach.

Polypharmacy is a common problem among older adults, as they are more likely to have multiple chronic conditions and may experience fragmentation of care among specialists. The Geriatrics 5Ms framework offers a person-centered approach to address polypharmacy and optimize medications, including deprescribing when appropriate. The elements of the Geriatrics 5Ms, which align with the approach of the Age-Friendly Health Systems initiative, include consideration of Medications, Mind, Mobility, Multicomplexity, and What Matters Most. Each M domain impacts and is impacted by medications, and learning about the patient's goals through questions guided by the Geriatrics 5Ms may inform an Age-Friendly medication optimization plan. While research on the implementation of each of the elements of the Geriatrics 5Ms shows benefit, further research is needed to study the impact of this framework in clinical practice.

No Wrong Floor on the Elevator: A Vision for the VA as an Age-Friendly Health System

The Age-Friendly Health Systems Initiative is a quality improvement movement led by the Institute for Healthcare Improvement and supported by the John A. Hartford Foundation to improve care for older adults. The US Department of Veterans Affairs (VA) has set a goal to become the largest integrated Age-Friendly Health System in the United States. As the veteran population ages, delivering Age-Friendly care is an urgent priority. VA clinicians should apply the 4Ms of the Age-Friendly Health Systems Initiative: Mobility, Mentation, Medications, and What Matters. No matter which floor a veteran exits on a VA elevator, they should expect to receive Age-Friendly care that will meet their needs as they age.

Promoting Safe Mobility Strategies for partnering with caregivers to maximize older adults' functional ability.

This article is the fifth in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Olson,L.M., et al. Promote Safe Mobility. Am J Nurs 2022; 122(7): 46-52.

The experience of hospital care for older surgical patients and their carers: A mixed-methods study.

A growing proportion of older adults are undergoing surgery, but there is a paucity of patient and carer experience research in this group. This study investigated the experience of hospital care in an older vascular surgery population for patients and their carers. This was a mixed-methods convergent design, including simultaneous collection of quantitative and qualitative research strands by combining open-ended questions with rating scales in a questionnaire. Recently hospitalised vascular surgery patients aged ≥65 years at a major teaching hospital were recruited. Carers were also approached to participate. Forty-seven patients (mean age 77 years, 77% male, 20% with a Clinical Frailty Scale score >4) and nine carers participated. The majority of patients reported that their views were listened to (n= 42, 89%), they were kept informed (n= 39, 83%), and were asked about their pain (n= 37, 79%). Among carers, seven reported their views were listened to and that they were kept informed. Thematic analysis of patients' and carers' responses to open-ended questions about their experience of hospital care revealed four themes in terms of what mattered to them: fundamental care including hygiene and nutrition, comfort of the hospital environment such as sleep and meals, being informed and involved in health-care decision-making, and treating pain and deconditioning to help recovery. Older adults admitted to hospital for vascular surgery and their carers, valued highly the care that met both their fundamental needs and facilitated shared decisions for care and recovery. These priorities can be addressed through Age-Friendly Health System initiatives.

Too Many Walls and Not Enough Bridges: Care Transitions Models to Support Older Adults with Mental Illness and Cognitive Impairment

Challenges in transitions of care can lead to increased morbidity, mortality, and increased health care costs. In particular, older adults with mental illness (MI) or cognitive impairment (CI) are particularly vulnerable when transitioning from different health care settings and back to the community. For instance, almost half of older adults with cognitive impairment who are discharged home from the emergency department return within 30 days. Similarly, older adults with MI and CI admitted to a skilled nursing facility are less likely to be discharged and, if discharged, spend less time in the community. Importantly, these outcomes mediated by the presence of depression, agitation, and functional impairment, highlighting the need for interventions that provide symptom management and address frailty.Some interventions have been shown to improve transitions from acute care to post-acute care. The Institute for Health Improvement Age Friendly Health System Initiative incorporates the 4 M model of what matters most, mobility, medications, and mentation framework in order to bring to together evidenced based initiatives that improve safety and outcomes for older adults. These interventions embed comprehensive geriatric care throughout the care continuum: hospitals, transitions out of hospitals, and post-acute and long-term care facilities. Other interventions have utilized home visits upon discharge to minimize readmission and increase time at home. Less is known about initiatives which address the role of subspeciality care and community-based organizations (CBOs) in maintaining older adults with MI and CI in the community.Montefiore Einstein is a fully integrated academic health system including 11 hospitals including a rehabilitation hospital, 65 primary care sites, 18 mental health/ substance abuse treatments clinics, a care management organization, and a home health program. Montefiore's Center of Excellence for Alzheimer's Disease (CEAD) has successfully expanded the delivery of comprehensive, high-quality, cost-effective care for people with CI. The CEAD is staffed with board-certified neurologists, geriatricians, psychiatrists, neuropsychologists and social workers. Our focus on the early diagnosis of Alzheimer's disease and related dementias helps patients and their caregivers prepare for the future and better manage the cost of care, potentially avoiding costly, unnecessary emergency room visits and hospitalizations. It was also recently designated an IHI-designated Age Friendly system. Montefiore Home Care (MHC), established in 1947, is the nation's first hospital- based certified home health agency. 40% of homebound older adults have MI and CI but have limited access to appropriate evaluation and treatment. Accordingly in 2004, MHC developed a consultative geriatric program in collaboration with the Division of Geriatric Psychiatry to provide comprehensive social work and geriatric psychiatry assessments in the home after discharge from hospital. In addition to the collaboration with MHC, Montefiore Division of Geriatric Psychiatry has leveraged foundational funding to collaborate with CBOs to bring evidence-based mental health services to seniors over the past two decades.During this session, presenters will describe several ongoing and new Montefiore initiatives to address care transitions for older adults with MI and CI. Dr. Zwerling will describe how the CEAD is spearheading the transition for Montefiore Einstein to an Age Friendly system. Ms. Korenblatt will highlight how the MHC Geriatric Psychiatry Program social work team serves as a bridge between acute care and CBOs to minimize hospital readmissions. Finally, Dr. Ceïde will highlight a specific example of an evolving partnership with one specific CBO in order to maintain older adults with MI and CI in the community.

Whole Health in Parts: Omissions from National Data Sets.

Background: The Whole Health model is a holistic approach to facilitate whole health practices by addressing (1) the physical, mental, and social health of individuals and (2) associated support systems. Several national organizations such as the Institute for Healthcare Improvement's (IHI) Age-Friendly Health Systems (AFHS) movement and, the U.S. Department of Veterans Affairs have implemented whole health frameworks with many common elements and promoted whole health practice and skills. However, implementing a Whole Health model across communities and health systems will require evidence of effectiveness. Generating evidence on the effectiveness of the Whole Health model's effect on health outcomes requires data-driven intelligence. Methods: We identified the national public-use data sets that are most often used in health research with a machine-assisted literature search of PubMed and Scopus for peer-reviewed journal articles published from 2010 through the end of 2021, including preprints, using Python [3.7]. We then assessed if the 8 most commonly used datasets include variables associated with whole health. Results: The number of publications examining whole health has increased annually in the last decade, with more than 2800 publications in 2020 alone. Since 2010, 24,811 articles have been published using 1 of these data sets. However, we also found a lack of data (ie, data set includes all of the whole health variables) to examine whole health in national data sets. Conclusions: We support a call to expand data collection and standardization of critical measures of whole health.

INFUSION OF AGE-FRIENDLY PRINCIPLES INTO CURRICULA USING INTERACTIVE MODULES

Abstract This presentation highlights the development of Age-Friendly care interactive modules to prepare the future healthcare workforce to care for older adults in Age-Friendly Health Systems. To date, there is a gap in the educational preparation of nurses, advanced practice nurses, and other health professionals to work in Age-Friendly Health Systems upon entry into practice. This project, funded by a faculty innovation grant at Seton Hall University, provides undergraduate and graduate nursing and interprofessional students with the background knowledge to care for older adults in Age-Friendly Health Systems. The aim of this project was to develop five interactive modules to embed in undergraduate and graduate nursing and interprofessional curricula focusing on the provision of care to older adults using the evidence-based 4Ms Framework: What Matters, Medication, Mentation, and Mobility. Faculty collaborated with instructional designers in development of the modules using Articulate 360 to embed them in curricula. The first module focuses on the background of the Age-Friendly Health Systems movement, how health systems may become an Age-Friendly Health System, and the evidence for the 4Ms Framework. The second module focuses on assessment and act on strategies related to What Matters to older adults including advance care planning strategies. The third module covers crucial information related to Medication such as avoiding potentially inappropriate medications, deprescribing, and antibiotic stewardship. The fourth module focuses on Mentation and covers assessment and act on strategies for depression, delirium, and dementia. The fifth module focuses on Mobility such as promoting mobility and decreasing fall risk.

EMBRACING DIVERSITY BY FOSTERING STRONG COMMUNITY CONNECTIONS

Abstract Age-Friendly Health Systems are essential; however, most health and healing take place outside of the walls of a hospital or physician’s office. Thus, it is imperative that health systems foster strong community connections, in particular with older adults from underserved communities who experience multiple barriers to quality, age-friendly health care. At Rush, there are several interdisciplinary initiatives designed to ensure that the 4Ms reach beyond the medical center and impact historically marginalized communities. In this symposium, we present three of these innovative approaches to bringing the 4Ms to into the community. Each presentation will describe the program and community served, explore how the 4Ms concepts are integrated, and present outcomes data on the program impact to date. Facilitating Caregiver Health and Wellness: Age-Friendly Health System Caring for Caregivers (AFHS-C4C) is an initiative to expand the age friendly health system to include caregivers. CATCH-ON Connect enables older adults to do What Matters to them by expanding virtual access to older adults, often from underserved communities. Finally, Rush@Home addresses the 4Ms by removing barriers to care and enabling older adults with medically complex needs to receive care in their home. The interactions of these programs will be discussed briefly by the session chair, along with service and policy implications of multiple programs addressing the 4Ms of an Age-Friendly Health System within one community.

ALIGNING GERIATRIC EMERGENCY CARE WITH THE 4MS OF THE AGE-FRIENDLY HEALTH SYSTEM FRAMEWORK

Abstract In 2019 Dartmouth-Hitchcock Medical Center (DHMC) was recognized by the Institute for Healthcare Improvement as a level 2 Age Friendly Health System (AFHS). Over the past two years DHMC leveraged the strengths of the AFHS to become a level 1 American College of Emergency Physicians (ACEP) accredited geriatric emergency department. Leveraging the paradigm of 4M care including: What Matter’s Most, Mobility, Medication and Mentation, DHMC achieved alignment between the geriatric emergency department accreditation and the AFHS framework. Pathways focusing on the 4Ms have been identified as a model to improve transitions of care post ED. This talk will focus on lessons learned and outcome data specific to the creation of the 4M pathways and transitions of care,

TEACHING MEDICAL STUDENTS TO INCORPORATE THE 4MS OF AGE-FRIENDLY HEALTH SYSTEMS ACROSS THE CONTINUUM OF CARE

Abstract High quality and equitable health care for older adults involves patient-centered approaches that can improve the patient’s engagement, decision-making, and health outcomes. To educate future health professionals about patient-centered care across the continuum of care, a HRSA-Geriatric Workforce Enhancement Program created a four-week online elective course for third and fourth-year medical students using the Age-Friendly Health Systems 4Ms framework. Faculty identified geriatric tools and best practices in the 4M’s areas of What Matters, Mobility, Mentation, and Medication to develop self-directed asynchronous learning modules. Students were instructed on incorporating the 4Ms into patient assessments, care planning, interprofessional practice, and process improvement in different settings of care. Assignments included quizzes, case studies, discussion forums, and a patient experience interview with an older adult or caregiver. At course completion, students self-assessed their knowledge and skills and rated the course materials and assignments using five-point Likert-type items. Ninety-six students participated in the course between July 2020 and March 2022. Ninety-eight percent of respondents (n=80) felt the assignments were helpful, and 100% agreed the course improved their knowledge about Age-Friendly Health Systems and different care settings and processes. Also, 100% felt the content was applicable to their future practice and 96% would recommend the course. Qualitative thematic analysis of open-ended questions showed preferences for interactive elements, such as case presentations and guided interviews with older adults, as well as ways to improve student engagement. Educating students about Age-Friendly Health Systems can prepare future health professionals for collaborative patient-centered geriatrics care across a variety of settings.

AN OLDER ADULT FRACTURE PROGRAM EMPLOYING AGE-FRIENDLY CARE CAN BE IMPLEMENTED AT YOUR HOSPITAL AND IMPROVE OUTCOMES

Abstract Older adult fractures are expected to increase dramatically over the next several decades, with hip fractures reaching an estimated 6.26 million worldwide by 2050. A combined approach to the care of older adult fracture patients was first reported in the early 1990s, emphasizing geriatric and orthopedic co-management. Early studies showed significant improvements in complications, function, and discharge rates to nursing homes. Subsequent studies demonstrated shorter time-to-surgery, lengths of stay (LOS), lower readmission rates, reduced in-hospital mortality, and lower cost of care. The studies are from large academic centers whose physicians are employed faculty or have dedicated geriatric units. Less studied is whether similar models could be implemented in community health systems/mixed practice settings like Cedars-Sinai. Cedars-Sinai’s older adult fracture program integrates inpatient and outpatient care and uses best practices of the 4Ms Framework of an Age-Friendly Health System, including What Matters Most, Mentation, Medications, and Mobility. The program was designed through the consensus of interprofessional champions and empirical evidence. Results showed enrolled patients with all fracture types had significantly lower LOS (marginal effect [ME]: -2.12, 95%CI: -2.61, -1.63), LOS index (ME: -0.33, 95%CI: -0.42, -0.25), and total direct costs (ME: -$5316.4, 95%CI: -6806.31, -3826.5). There was no significant difference in time-to-surgery. Of the 746 enrolled patients, 170 (23%) had a post-discharge visit with a participating geriatrician within 6 months. Findings indicate a systematic approach to improving care for older adults with fractures improves inpatient outcomes in a mixed practice setting. Future studies will examine the effectiveness of Cedar-Sinai’s outpatient program.