By: Jessica M. Bingham and Mary Dolansky
Team skills are not new, especially in geriatric care. In 2003, now President of The John A. Hartford Foundation, Dr. Terry Fulmer, led an initiative to improve interprofessional geriatric care through the Geriatric Interdisciplinary Team Training Program (GITT) https://doi.org/10.1111/jgs.17571 . This program spread across the US and promoted the use of team skills in the advancement of geriatric care. As our population ages rapidly, it is critical to integrate team skills to address the complex nature of geriatric care. This will be a challenge for professionals who are not familiar with or educated about geriatric care.
The John A. Hartford Foundation (JAHF),https://www.johnahartford.org/grants-strategy/current-strategies/age-friendly/age-friendly-care, one of the largest philanthropic organizations in the US advocating for older adults, recognizes the pressing need to ensure that all older adults receive Age-Friendly Health System (AFHS) 4Ms care. The 4Ms framework includes a simple set of evidence-based care that includes the assessment and acting on What Matters, Medications, Mentation, and Mobility. The movement funded by The JAHF initiative is coordinated by the Institute for Healthcare Improvement (IHI) who has a lofty goal of reaching older adults in 3,600 hospitals, practices, convenient care clinics, and nursing homes that apply the 4Ms equitably by June 30, 2026.
This shift to deliver evidence-based care requires that every healthcare professional and health professions student has the knowledge, skill, and attitude to deliver 4Ms care. Education to all professionals requires not only the core knowledge of the 4Ms, but also integrating the 4Ms
Each “M” encapsulates a realm of considerations necessary for ensuring the well-being of older individuals during clinical visits and , understanding the intricacies of the 4Ms—What Matters, Medications, Mentation, and Mobility—is crucial.
What Matters delves into the core aspects that hold significance in an older adult’s life. Whether related to their overall health or specific preferences during clinical interactions, this understanding forms the cornerstone of compassionate care.
‘Medications’ involves an assessment of prescribed and over-the-counter drugs and their potential impact on various aspects of life. Does a medication hinder activities that matter most to the individual? Are there effects on cognitive functions or mobility?
‘Mentation’ involves assessing depression, delirium, and dementia and identifying risks of decline.
‘Mobility’ quantifies daily movement, aiming to maintain optimal mobility for an enhanced quality of life.
In Practice
While implementing the 4Ms is crucial, it’s equally vital to emphasize that effective execution requires robust team skills. Although the AFHS movement does not include how to work in teams, Organizations like the Geriatric Practice Leadership Institute (GPLI) https://www.unthsc.edu/center-for-geriatrics/healthcare-professionals/geriatric-practice-leadership-institute-gpli/ are championing this cause, training healthcare professionals teamwork to excel in age-friendly care. The Geriatric Practice Leadership Institute (GPLI) is a comprehensive program designed to equip interprofessional healthcare teams with the leadership skills and expertise necessary to become clinical leaders within their organizations. By integrating the Institute for Healthcare Improvement (IHI) Age-Friendly Health Systems 4Ms Framework, GPLI empowers participants—early and mid-career professionals—from two collaborating universities. The focus is on fostering interdisciplinary teamwork, enhancing leadership abilities, and implementing age-friendly care practices for older adults. Aligned with the Institute for Healthcare Improvement’s 4Ms framework, GPLI aims to cultivate a cohort of practitioners capable of spearheading geriatric evidence-based approaches within their respective healthcare settings, thereby enhancing outcomes for older adults. Team skills play a pivotal role in navigating the complexities of caring for older adults. Team skills include effective communication, understanding and respecting each other’s unique role, and having a common goal. TeamStepps is a national program supported by the American Hospital Association https://www.aha.org/center/team-training/getting-started-teamstepps to teach and promote teamwork and collaboration. Specific to age-friendly care, teamwork might include a pharmacist addressing medication concerns, physical and occupational therapists assessing mobility, nurses assessing for depression, and social workers managing complex circumstances affecting what matters. Having each of these professionals understand that they all have a common goal and each respects their individual roles and expertise contributes to the team approach to age-friendly 4Ms care. As a part of standard geriatric care, many facilities have interprofessional care rounds, often including patients and family members. During interprofessional care rounds, each professional shares their expertise and the team moves forward to integrate this coordinated care. In settings outside of geriatrics, health care professionals might consider interprofessional huddles to coordinate care once a day.
The success of age-friendly care hinges on effective team dynamics, influencing not only the appreciation for 4Ms care but also the recognition of the collaborative team’s value. Results from programs like GPLI and the interprofessional education at Akron University show enhanced team dynamics. Meanwhile, educational efforts focused solely on specific disciplines, such as dental and second-year medical students, led to increased appreciation for age-friendly practices. Acknowledging the perceived value is pivotal in propelling change and adoption, crucial aspects in catering to the needs of our aging population.
In Academia
Education doesn’t solely revolve around practicing clinicians. Forward-thinking institutions are reshaping their curricula to equip future healthcare providers with the necessary skills. Dental and medical schools are incorporating age-friendly care principles early on, fostering a generation of compassionate and informed providers. The Institute for Healthcare (IHI) https://www.ihi.org/education/ihi-open-school has an Age-Friendly Health Systems learning module in their open school. Age-Friendly Health Systems Open School Course has a free Open School course, PFC 203: Providing Age-Friendly Care to Older Adults, provides an understanding of the Age-Friendly Health Systems movement, actionable steps to get started, and how to improve the care of older adults in your setting. This education is accessible to students to learn the assessment and actions needed to provide evidence-based geriatric care.
Interprofessional education programs, like those at the University of Akron in Ohio, are revolutionizing the learning experience. Pairing nursing students with peers from various disciplines instills a deep appreciation for team dynamics and the value of the 4Ms in holistic care.
Delivering AFHS 4Ms care through an interprofessional approach is essential for ensuring the most comprehensive and secure method of providing age-friendly care. The complexity of caring for older adults necessitates the involvement of diverse experts collaborating towards a shared goal: the well-being of the patient.
For the safe and thorough delivery of age-friendly care, employing an interprofessional method centered around the AFHS 4Ms is crucial. The intricate nature of elderly care demands a team of varied experts working together toward the common aim of ensuring the best outcomes for the patient.
Acknowledgment: 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 (AHA) and the Catholic Health Association of the United States (CHA).
About the authors:
Jessica M. Bingham BSN,RN, is a PhD student and a Legacy Fellow at the Frances Payne Bolton School of Nursing, Case Western Reserve University. She is also a facilitator with the Fuld Institute at Ohio State University and facilitates evidence-based practice immersions. She is an Assistant Nurse manager of the spinal cord unit at the VA North East Ohio Health System and serves on the research and evidence-based practice committees.
Mary Dolansky PhD, RN, FAAN is the Sarah C. Hirsh Endowed Associate Professor at the Frances Payne Bolton School of Nursing and Associate Professor at the School of Medicine at Case Western Reserve University. She is the director of the Hirsh Institute, which aims to catalyze change in healthcare. She serves as the senior faculty for the VA Quality Scholars program at the VA North East Ohio Health System. She is currently leading an academic-clinical partnership implementing the Age-Friendly Health Systems into 1,000 MinuteClinics across the county, funded by The John A. Hartford Foundation. Her interprofessional research, education, and leadership have resulted in over 149 publications including the massive open online course, Take the Lead for Healthcare Improvement. Her passion is improving the health of older adults through system-based interventions.
References
Brown, D., Hovland, C., Fosnight, S., Chrzanowski, B., Gergis, M., Patton, R., & Simpson, D. (2023, November 8–12). A model for training students age-friendly concepts using virtual interprofessional simulation [Poster presentation]. GSA, Tampa, Florida, United States.