As a provider, how do you ensure that older adults are getting comprehensive care, and that all their issues are identified and addressed? Anne Jenks, a Family Nurse Practitioner who works at MinuteClinic inside a CVS Pharmacy in Tennessee, has seen the benefits of using the 4Ms Framework — What Matters, Medication, Mentation, and Mobility — when working with her elderly patients. She recently credited the framework with helping her identify a serious issue with a patient that may easily have been overlooked without it.
The 4Ms Framework is the core of the Age-Friendly Health Systems (AFHS) initiative, which was launched in 2017 by 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). Age-friendly care entails reliably providing the 4Ms — a set of four evidence-based elements of high-quality care — to all older adults (see Figure 1).
Figure 1 — The Age-Friendly 4Ms Framework
MinuteClinic, the retail clinic of CVS Health, has partnered with Case Western Reserve University and the Frances Payne Bolton School of Nursing to join the Age-Friendly Health Systems movement and adopt the 4Ms across its 1,100 locations.
Implementing the 4Ms means assessing and acting on them for all older adult patients. Jenks recently went through each of the 4Ms with one of her patients. They first discussed What Matters, Mobility, and Medications, all of which were straightforward. But when it came time for the Mentation component, the older adult told Jenks that she felt as though she had been having “memory issues” lately.
Jenks conducted a brief assessment called the PHQ-2. The PHQ2 is commonly used to screen for depression. It asks about the degree to which an individual has experienced depressed mood and anhedonia (difficulty experiencing pleasure) over the past two weeks.
In this case, the older adult scored 6/6, the highest possible score. Jenks then administered the PHQ-9, a longer version of the assessment. The patient’s high score indicated symptoms of depression. She disclosed to Jenks that she had been on an antidepressant medication in the past, but she could not remember the name. Jenks emphasized that she didn’t need to “tough it out” and that her primary care physician (PCP) could help her get back on her medication if she wished, as well as refer her to a therapist. “She absolutely needed help,” said Jenks.
Jenks informed her that depression can affect memory, so it was possible that her depression was the cause of the memory issues she had mentioned. However, Jenks added, even if there were a larger issue with her memory, interventions are available that may be able to slow the process of memory loss. The patient was visibly relieved to hear this. Jenks advised her to call her PCP that day. With the patient’s permission, Jenks also called her PCP and gave a report on her visit.
Overall, the experience reinforced for Jenks the importance of the 4Ms framework. “If we didn't have age-friendly care in place,” said Jenks, “I might not have explicitly asked her the PHQ-2, which would have led to her likely not receiving or delaying the care she needed.”
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