Summary
- Caring for older adults requires specialized knowledge and intentional alignment across teams. Dr. Kimberly Smashe shares insights about establishing shared understanding through the Certified Professional in Age-Friendly Healthcare (CPAFH) credential.
Caring well for older adults requires more than applying standard approaches with extra caution. Aging introduces changes in physiology, cognition, function, and social context that directly affect outcomes, yet health care systems do not always account for these factors consistently.
For Kimberly Smashe, DNP, MBA, RN, GERO-BC, ACM-RN, NE-BC, CPAFH, Geriatrics and Care Transitions Manager within Duke University Health System’s Population Health Management Office and faculty member for the Certified Professional in Age-Friendly Healthcare (CPAFH) review course, this gap has been visible throughout her career. Her experience earning the CPAFH credential and teaching others to do the same has reinforced the importance of shared understanding, validated expertise, and alignment across teams.
When Good Care Plans Fall Short
One patient encounter early in Dr. Smashe's career brought this lesson into focus. The care team had developed what appeared to be a strong plan. Medications were optimized, follow-up visits were scheduled, and support services were arranged.
Within days, the patient returned.
“Nothing had gone wrong in a technical sense,” Dr. Smashe recalls. “The plan simply didn’t match the patient’s life.”
Subtle cognitive changes made medication management difficult. Mobility challenges created barriers at home. Support that seemed sufficient in a clinical setting did not hold up in practice.
Experiences like this highlight a common challenge. Without an intentional age-friendly lens, even well-designed care plans can miss what matters most.
Over time, Dr. Smashe began to see a pattern of similar missed opportunities. “These weren’t failures of effort,” she explains. “They were gaps in training and systems.”
Painting a Picture of Success
Imagine an older adult admitted with pneumonia who tells the care team during a What Matters conversation, “My biggest goal is to get back home and stay independent. I don’t want to end up back in the hospital or in a nursing facility.”
With a shared age-friendly language and common goal of supporting what matters to the patient, the care team knows how to put the 4Ms into action. Medications are reviewed for anything that could increase the risk of falls or confusion during the hospital stay or after discharge. Nursing focuses on preventing delirium and encourages mobility throughout the hospitalization. Physical therapy works with the patient early to help maintain strength and independence.
Instead of everyone working in separate silos, the entire team is working toward the same goal – treating the pneumonia while preserving the patient’s functionality and independence. As a result, the patient avoids complications, returns home sooner, and is less likely to be readmitted. Just as importantly, the patient feels heard and knows their care was built around their personal goals, creating a better experience for both the patient and the care team.
Reinforcing Skills in Practice
Health care professionals care deeply about their patients, but many receive limited formal training in geriatrics unless they specialize in it. This can lead to variation in how aging-related needs are identified and addressed.
The CPAFH credential helps create a shared foundation. It validates knowledge and reinforces core principles that support safer, more equitable, and more person-centered care. Aligned with the 4Ms Framework — What Matters, Medication, Mentation, and Mobility — it strengthens how teams approach aging as an integrated whole.
When Dr. Smashe completed the CPAFH exam, she found that it affirmed much of her existing practice while sharpening her perspective.
“The exam made clear that age-friendly care isn’t a collection of isolated skills,” she says. “It’s an integrated approach.”
Certification reinforces how medications affect older adults differently, how changes in cognition and function shape care needs, and how plans should align with individual priorities. It also helps clinicians see how their work connects with the broader care team. By reinforcing these concepts across disciplines, CPAFH can support more consistent approaches to care.
As faculty for the CPAFH review course, Dr. Smashe has observed how participants respond.
“One of the most meaningful moments is when people recognize what’s missing,” she says. “They gain confidence in what they know, while also seeing where small gaps can make a difference.” Participants often describe feeling more prepared to ask questions, raise concerns, and advocate for care that reflects what matters to older adults.
Skills Teams Need Today
Expectations for care teams have shifted.
“It’s no longer enough to be excellent within your own role,” Dr. Smashe says. “Teams need to understand how their work connects and how decisions affect the person as a whole.”
This requires collaboration and a shared language. At the same time, it depends on returning to core principles. “In complex systems, it’s easy to rely on protocols,” she notes. “But with older adults, those pathways always need to be adapted.” Balancing consistency with individualization remains essential.
Dr. Smashe is often asked whether certification adds value for experienced clinicians. “Each role brings expertise and blind spots,” she explains. “Certification helps broaden perspective.”
By validating knowledge and reinforcing shared principles across roles, CPAFH supports more coordinated and informed decision-making. “If we care well for our most complex patients,” she says, “there’s a ripple effect across the system.”
Kimberly Smashe, DNP, MBA, RN, GERO-BC, ACM-RN, NE-BC, CPAFH, is the Geriatrics and Care Transitions Manager at the Duke Population Health Management Office.
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