Outcomes Evidence Must Keep Up with the Implementation of the 4Ms Framework to Ensure Age-Friendly Health System Transformation

The Age-Friendly Health System (AFHS) movement was conceptualized as a transformative solution to reliably deliver evidence-based care to older adults. Guided by the 4Ms framework: What Matters, Mobility, Mentation, and Medication, AFHS healthcare systems have been given the flexibility to tailor 4Ms interventions and care processes to their context, preferences and populations. This flexibility has facilitated the widespread adoption of 4Ms care. However, as our understanding of 4Ms implementation grows, evidence of the impact of 4Ms care on outcomes must keep up with implementation to ensure AFHS transformation. It is only through assessing the 4Ms as a whole and understanding the interplay between the Ms in relationship to outcomes that we can understand: (1) value-generation to-date, (2) how variation in 4Ms implementation can maximize equitable value realization, and (3) if, and how, to expand the framework most effectively. We propose seven strategies to catalyze the generation and dissemination of robust evidence to support AFHS transformation. These strategies are organized around activities that individual healthcare delivery organizations, researchers and evaluators, and other key informants can pursue. Expanding evidence generation and disseminating findings using these proposed strategies will support the 4Ms framework as an effective vehicle for improving health outcomes for older adults.