Creating Age-Friendly Health Systems

The Health of Aging Populations Delivery System Reform

In the 1990s, the notion of “elder-friendly” care began emerging, likely in response to the “baby-friendly hospital” initiative.  While it was slow to catch on, about a decade later, the World Health Organization, AARP, and others began in earnest efforts to create designations for age-friendly cities and communities. In such communities, the physical environment, transportation options, housing, and community services are accessible for people of all ages. Today the scope of age-friendliness has expanded far beyond cities to encompass university campuses, businesses, health care systems, public health systems, and entire states. These elements together comprise what we at the John A. Hartford Foundation call an emerging, propitiously timed “age-friendly ecosystem.”  


The Age-Friendly Ecosystem

Source: Adapted from Patel et al. (under review, Journal of the American Geriatrics Society).

The idea that age-friendly health systems in particular can be developed has accelerated in the last five years as policymakers and state legislative leaders have engaged in the issue. Age-friendly health systems reliably deliver evidence-based care across all settings, cause no harm, and align all care with what matters to the older adult and their family caregivers. The Age-Friendly Health Systems initiative, funded by The John A. Hartford Foundation and led by the Institute for Healthcare Improvement, has developed a framework called the 4Ms of age-friendly care. This framework involves an essential set of care elements that together improve outcomes for older adults: What Matters, Medication, Mentation and Mobility.  In each of these areas, there are evidence-based practices that every older adult should receive.

In 2018, Governor Andrew Cuomo of New York State announced that 50% of its health systems would be age-friendly in five years, building on New York’s designation as an age-friendly state. The focus on health systems makes sense in that there can be no age-friendly city or state in the absence of an age-friendly health system. The John A. Hartford Foundation’s Age-Friendly Health Systems initiative is partnering with the New York’s health department, the Healthcare Association of New York State, and three other foundations to establish a New York State Age-Friendly Health Systems Action Community, or learning collaborative, in 2020 to help health systems adopt the 4Ms framework.

Colorado and Massachusetts are neck and neck with New York when it comes to making progress on becoming more age-friendly.  In Colorado, for example, the Governor Jared Polis announced “Lifelong Colorado” in 2018 in order to designate Colorado as an AARP Age-Friendly State, and cities such as Colorado Springs have committed to becoming AARP age-friendly communities. In Massachusetts, Governor Charlie Baker announced an action plan to make that state not only more age-friendly but also more dementia-friendly. Clearly there is a movement to anticipate the needs of older adults advancing across the country.

At the federal level, the Health Resources and Services Administration (HRSA) has made adoption of the age-friendly health systems 4Ms approach to care a requirement for the academic health centers, primary care practices, and community-based organizations that partner with the 48 Geriatrics Workforce Enhancement Program (GWEP) sites, which are receiving $35 million annually from HRSA between 2019 and 2024.  This support, in turn, has accelerated health care workforce training in age-friendly approaches to care.  For example, GWEP sites are training clinicians in how to deprescribe potentially inappropriate medications for older adults, as well as construct mobility plans that enhance strength and decrease the likelihood of falling among older patients.

It has also been heartening to work with the Administration for Community Living and the U.S. Department of Health and Human Services (HHS) as they have advanced their work in health promotion and healthy aging for older adults. The first HHS Healthy Aging Regional Workshop was held in Boston in September 2019. The goal is to hold workshops in all regions of the country to signal the importance of these initiatives and the opportunities to improve care for older adults.

In addition, Trust for America’s Health is leading an initiative focused on improving the capacity of regional public health offices to assess and care for older adults in the community, in partnership with area agencies on aging. With the looming demographics, along with the guarantee of more older individuals with cognitive impairment and dementia, now is the time to knit together all of our precious resources and become aligned in an age-friendly ecosystem approach to care and support of older adults.

As government officials and public health leaders take on this mantle, we can only hope and assume the workforce and public-at-large will follow—or maybe lead? We can imagine a time soon where older adults will ask their primary care provider, “Do you provide age-friendly care? Can you review my 4Ms with me?”

We can also imagine a robust set of age-friendly activities in every community that work seamlessly across the continuum of care, as well as the continuum of life for older persons. Technology will have a powerful role to play, particularly to reach older individuals in rural settings, as well as those people who are limited in their mobility or mental capacity.

At the same time, to realize this future, we have work to do to uncover the myths that go along with aging.  A recent survey conducted by WebMD revealed that older adults want to engage in age-friendly health care conversations, but that misconceptions about the aging process are common. For example, the survey found that 40% of older adults reported believing that depression is a normal part of aging, which is not true.

In the age-friendly ecosystem that’s being created, older adults and their families will receive a consistent message about the potential for healthy aging, as well as health promotion, disease prevention, and appropriate expectations of health systems in our country.

Terry Fulmer is the President of the John A. Hartford Foundation