Age-Friendly Care Practices: Documenting Opportunities for Improvement

TL;DR

This study examines age-friendly care practices in a hospital to identify areas for improvement before federal requirements take effect.

Contribution

The study provides early documentation of age-friendly care processes in a Midwestern hospital ahead of CMS structural measures.

Findings

Most patients showed no improvement in mobility during hospitalization.

Two-thirds of patients received CAM screenings twice daily.

Only 4.7% of patients received geriatric consultation services.

Abstract

Efforts to address the multifaceted clinical and social needs of an aging population have centered around the Age Friendly Health System (AFHS) framework of 4Ms: Medication, Mentation, Mobility and what Matters. In 2025, hospital-wide AFHS structural measures were adopted by CMS, with both cost and quality implications. This study describes early efforts to document AFHS processes across a large Midwestern academic medical center. Using electronic health record data, we analyzed 447 unique patient encounters across two hospital units between July-September 2024. Mobility was measured using the bedside mobility assessment tool (BMAT), Mentation via the confusion assessment method (CAM) at least twice daily, Medication by use of antipsychotics, sedatives, and/or anticholinergics (i.e. monitored medications), and what Matters by person-reported location of expected discharge. On average, patients were 77.9 (+/- 6.3) years, with a median length of stay of 4 days (IQR=5) and an unadjusted 30-day readmission rate of 14.5%. The geriatric consult service saw 4.7% of patients. The majority (64.9%) of patients saw no improvement between admission and discharge BMAT. Roughly two-thirds of patients were administered a CAM screening twice daily, and 83.2% of patients received a monitored medication at least once. Finally, agreement between actual and expected discharge home was approximately 80%. Systematic tracking of age-friendly care facilitates early interventions aimed at standardization and prioritizes an environment of continuous learning. Our work identifies areas for targeted improvement prior to system-wide implementation of federal requirements and prompts further investigation into how geriatric consultation services can be leveraged to fill observed gaps.