Age-Friendly Health Systems: Guide to Using the 4Ms in the Care of Older Adults

Implementation Tool
July 2020


This step-by-step guide contains robust tools for health systems to apply the 4Ms framework to deliver age-friendly, evidence-based care for older adults.


The Age-Friendly Health Systems movement, started in 2017 by The John A. Hartford Foundation and the Institute for Healthcare Improvement in partnership with the American Hospital Association and Catholic Health Association, follows the 4Ms framework (What Matters, Medication, Mentation, and Mobility) to better meet the needs of older adults by providing age-friendly care. This guide is designed to assist care teams across settings with implementing evidence-based, geriatric best practices that correspond to the 4Ms.

About this Tool

This guide includes many tools to help health systems put the 4Ms into practice, each grouped into the following six steps:

  1. Understand current state of providing age-friendly care by assessing the older adult patient population and selecting a care setting to begin testing best practices;

  2. Develop descriptions of care consistent with what the 4Ms look like in different health care settings;

  3. Design or adapt activities, processes, and workflows to align with the 4Ms.

  4. Provide care that aligns with the 4Ms, testing first with one patient and then scaling up to include more patients;

  5. Evaluate performance, which can include input from the care team and older adults and their caregivers as well as measuring the 4Ms with real-time observations; and

  6. Continually improve processes to support sustainability and reliability of quality care that aligns with the 4Ms.


Health systems interested in becoming age-friendly can use this guide to assist in initial testing and implementation of the 4Ms framework to improve quality of care for older adults.

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