From Community to Care: CHWs Advancing Age-Friendly Health in FQHCs

TL;DR

Community Health Workers (CHWs) were trained to use the 4Ms framework to improve geriatric care in health centers, showing significant knowledge gains and high adoption of the approach.

Contribution

This study demonstrates the effectiveness of integrating CHWs into Age-Friendly Health Systems using the 4Ms framework and highlights areas for improvement in documentation and dementia screening.

Findings

CHWs showed significant post-training knowledge gains in geriatric care (p = .026).

Documentation of the 4Ms was high for Medication, Mobility, and What Matters, but lower for dementia screening.

Only 31% of encounters included full completion of all 4Ms components.

Abstract

The growing older adult population in the U.S. has increased demand for health care professionals with specialized training in geriatrics. Geriatric Workforce Enhancement Programs (GWEPs) across the country are tasked with training Community Health Workers (CHWs) to meet this need. This project integrated CHWs into Age-Friendly Health Systems (AFHS) using 4Ms framework (What matters, Mentation, Medication, Mobility). Goals included assessing changes in CHWs knowledge, intent to use training, and baseline geriatric screenings.

Twelve CHWs completed a 30-hour in-person geriatric care training covering syndromes, community resources, patient-centered care, and the 4Ms of AFHS. Pre/post surveys captured demographics, satisfaction, and self-rated knowledge. The Wilcoxon Signed-Rank Test assessed changes in knowledge. CHWs documented 4Ms discussion with older adults (65+) using the electronic health record (EHR) unstructured notes section and spreadsheets. Data from 55 chart reviews (Feb- April 2025) were assessed for screening rates and documentation consistency.

CHWs were 73% female, 45% White, with an average age of 40 years. Pre-training, 36% rated their knowledge as moderate; post-training, 91% reported high knowledge and high likelihood of applying information. Knowledge gains were statistically significant (z = -2.23, p = .026). CHWs documentation for Medication, Mobility, and What Matters was 100%; Mentation screening was 87% for depression, 31% for dementia, with full completion of all 4Ms in 31% of encounters.

Findings suggest strong adoption of the 4Ms components, ease of documentation, with opportunities for improvement in dementia screenings and overall 4Ms completion. Strengthening EHR infrastructure is needed to support age-friendly care.