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About this IHI Virtual Expedition

​Every day in the US 10,000 people turn 65. The number of adults over the age of 65 is projected to double over the next 25 years. Approximately, 80% of older adults have at least one chronic disease and 77% have at least two.

Older adults have higher rates of health care utilization compared to other age groups, and many of our health systems are ill-equipped to deal with the social complexity that many older adults face. They also experience higher rates of health care related harm, delay, and dis-coordination. A consequence of this harm, delay, and dis-coordination has led to older adults using the emergency department (ED) four times more than younger populations.

The 4Ms and Age-Friendly Health Systems

The 4Ms are the essential elements of high-quality care for older adults and, when implemented together, indicate a broad shift by health systems to focus on the needs of older adults.

Most health systems are practicing the 4Ms with some older adults, some of the time. The 4Ms are:

  • What Matters: Know and align care with each older adult’s specific health outcome goals and care preferences including, end-of-life care and across settings of care;
  • Medication: If medication is necessary, use age-friendly medications that do not interfere with what matters, mentation, or mobility;
  • Mentation: Prevent, identify, treat, and manage dementia, depression, and delirium across settings of care; and
  • Mobility: Ensure that older adults move safely every day to maintain function and do what matters to them.

Get a team together for this action-focused, virtual team training starting February 5, 2019 and learn how to try and integrate the 4Ms into care every day, with every older adult in your health system.


What you'll learn

At the end of the Expedition each participant will:

  • Describe the 4Ms and how they interact with each other
  • Define potential pathways for implementing the 4M approach 
  • Share lessons learned from successful initiatives

This IHI Virtual Expedition is approved for a total of 7.5 continuing education credits for nurses and physicians.


Session 1: Age-Friendly Health Systems and the 4Ms
Date: Tuesday, February 5, 2019, 1:00 PM–2:30 PM ET

Session 2: Know the 4Ms for Each Older Adult in your Care (Part 1)
Date: Tuesday, February 12, 2019, 1:00 PM–2:30 PM ET

Session 3: Know the 4Ms for Each Older Adult in your Care (Part 2)
Date: Tuesday, February 26, 2019, 1:00 PM–2:30 PM ET

Session 4: Incorporate the 4Ms into the Plan of Care (Part 1)
Date: Tuesday, March 12, 2019, 1:00 PM–2:30 PM ET

Session 5: Incorporate the 4Ms into the Plan of Care (Part 2)
Date: Tuesday, March 26, 2019, 1:00 PM–2:30 PM ET   

Learn more about course Materials and Technology.​​


Donna Fink Donna Marie Fick, MSN, PhD, is the Elouise Ross Eberly Endowed Professor of Nursing and Director of the Penn State Center for Geriatric Nursing Excellence. Her area of research has focused on two issues in the care of older adults, medication use in older adults and delirium superimposed on dementia (DSD). She is a member of the interdisciplinary panel for the American Geriatrics Society Beers Criteria (AGS) for inappropriate medication use in older adults, and serves on their board. She also serves on the National Academy of Sciences, Engineering and Medicine Forum on Aging, Disability and Independence. Her current NIH funded study is with Edward Marcantonio, MD with the Harvard School of Medicine that is testing an ultra-brief screening tool for delirium enrolling over 500 older adults and clinicians in sites in PA and MA. Dr. Fick widely disseminates her work through over 100 publications, media coverage, and national and international presentations. Dr. Fick received her BSN from Berea College, her MSN from the University of Cincinnati, and her PhD from the University of California, San Francisco.

Albert Siu Albert L. Siu, MD, MSPH, is Professor of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, and the director of the Geriatric Research, Education, and Clinical Center (GRECC) at the James J. Peters Veterans Affairs (VA) Medical Center. He is the Chair Emeritus(Chair from 2003-17) of the Department of Geriatrics and Palliative Medicine—one of the largest geriatrics programs in the nation. Dr. Siu earned his M.D. from Yale Medical School and an M.S.P.H. at the University of California, Los Angeles (UCLA) School of Public Health. Dr. Siu served for 12 years on the US Preventive Services Task Force as a member, Vice Chair and Chair. He is a senior associate editor at Health Services Research. Dr. Siu's research aims to improve the quality and delivery of care provided to geriatric populations. His studies have focused on the measurement and improvement of functional outcomes in the elderly, as well as evaluations of system interventions to improve the care for chronic illness.

Leslie Pelton Leslie Pelton, Senior Director, IHI, has more than 17 years of experience managing, leading, and facilitating successful organization transformation and performance improvement in the health care industry. She works in academic medical centers, community hospitals, physician practices and community health centers to advise leaders on improvement strategies, especially as they relate to design and implementation of accessible and effective care. In addition to advising leaders and teams, Ms. Pelton conducts individual leadership development coaching with a specialization in supporting physicians as leaders. She brings to each of these individuals and organizations in-depth experience with strategic planning, leadership and team development, and organizational change. Prior to joining IHI, Leslie was Principal of LJP Consulting which she founded and led after eight years at Deloitte Consulting. Leslie has her Master’s in Public Administration from the University of Pennsylvania and her BA from Connecticut College.