Ensuring Health Systems Become Age-Friendly


An exciting, long-overdue and much-needed movement is underway to close current gaps and failures in health care for older adults so that it better meets our needs as we age. The Age-Friendly Health Systems initiative, conceptualized in 2015 and launched in 2017, has sparked innovation and improvement across the country and presents a ripe opportunity for community-based organizations to further collaborate with clinical partners. Together, these collaborations can ensure that older adults receive the best care possible across settings—care with better transitions that reduces the risk of harm and poor outcomes, increases satisfaction and achieves greater value for everyone.

Area Agencies on Aging and other community-based organizations that serve older adults living in the community have long-standing and deep expertise in age-friendly care and come at the work in creative and individualized ways. Whether through care planning that prioritizes what truly matters to older adults, programs that provide support to family caregivers of older people with dementia, evidence-based health and wellness programs that help older adults remain mobile, or medication monitoring programs like HomeMeds, community-based organizations play a pivotal role in making care more age-friendly.

However, these organizations have not always been able to fully integrate with acute care settings. The Aging and Disability Business Institute, led by n4a, with support from The John A. Hartford Foundation and others, is changing this by building the capacity of community-based organizations to create sustainable partnerships with health systems to effectively meet the needs of older adults, people with disabilities and their families.

Partnerships are critical at all levels. At The John A. Hartford Foundation, we knew the work of creating age-friendly health systems was going to be extremely challenging so we also sought and found exceptional partners to make these ideas and ideals come to life. The Institute for Healthcare Improvement (IHI) immediately stepped up to partner with us to ensure we had the right people at the table to move us forward. Straightaway, the American Hospital Association and the Catholic Health Association of the U.S. also agreed to join. Together, we have been developing and testing an innovative model of care for older adults in five health systems that cover more than 30 states. Our goal: to bring age-friendly care to 20 percent of U.S. hospitals and health systems by 2020.

The Age-Friendly Health Systems model rests on addressing what we refer to as the critical, essential “4Ms,” which will strongly resonate with community-based organizations that serve older adults:

  • What Matters: Knowing and acting on each other older adult’s specific health goals and preferences
  • Medication: Using age-friendly medications that facilitate mobility, mentation and “de-prescribing” medications that are harmful or unnecessary
  • Mentation: Identifying and managing depression, dementia and delirium
  • Mobility: Ensuring that older adults move every day

National experts in geriatric care and IHI’s quality improvement coaches have been working with the participating systems to implement and test interventions that address the interactive 4Ms. By more reliably and systematically delivering better care across these domains and care settings, health systems can achieve what we are already seeing in many of our prototyping sites: decreased length of hospital stays, reduced avoidable hospital readmissions and higher levels of satisfaction from patients and families.

We are rapidly moving into the next stages of the initiative to spread to others what we are learning. An Action Community of 100 health care teams will begin working and learning together in September to expand the age-friendly model of care to additional sites within our five participating systems, and beyond to other health systems. As we begin this expansion, community-based organizations are invited to join as vital partners in achieving the initiative’s aims.

By working together, we can look forward to the day when our health systems, communities and all of society will be age-friendly. People will wonder why it was ever any different.