“Caring for our seniors is possibly the greatest responsibility we have. Those who have walked before us have given so much and made possible the life we all enjoy.”1 The SGIM Forum editorial team in conjunction with our Special Guest Editors bring this theme issue on geriatric care to SGIM members to improve the care of our older patients, a task that includes initiative and advocacy. Eventually, most of us will need a caring and empathetic healthcare provider to negotiate the healthcare system and promote our health and well-being as we age. The articles within this theme issue will assist us in becoming more aware of current healthcare topics.
Worldwide, there is a growing movement to foster healthy aging across nations. The World Health Organization (WHO) introduced a global action plan for health care in older adults in 20162 through the adoption of the following five age friendly strategies:
- Creating national frameworks for health aging in every nation with collaboration between all sectors of health care including national, state, and private institutions, as well as scientists, clinicians, hospital administrators and political players.
- Development of appropriate and friendly health environments for older adults with adequate coordination between different health sectors, making it easier for patients to seek and navigate health care, while also promoting optimal health.
- Better alignment of health systems to cater to the needs of older adults. This is to ensure that older persons have access to basic and advanced medical services for their complex medical needs and preferences.
- Developing appropriate health systems for geriatric long term care including home care, community services such as adult day care centers, program of all-inclusive care of the elderly (PACE), and institutional services in skilled nursing and assisted living facilities.
- Finally, developing effective methods to evaluate different components of health care and health initiatives for older persons to ensure that there is consistent improvement and that their health needs are met.
Many nations have since embraced and adapted these health strategies to enhance the care of their older population.
In 2017, the John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) introduced the Age Friendly Health Systems initiative which, in conjunction with American Hospital Association and the Catholic Health Association of the United States, worked to address the challenges of medical care of our growing older American adult population. Age Friendly Health Care aims to incorporate evidence-based clinical practices aligned with patient preferences and goals of care into every patient interaction. The concept centers around the 4Ms framework—Mobility, Mentation, Medication, What Matters—as well as the subsequent addition of the 5th M, Multicomplexity, which are the foundational aspects of geriatric assessments and clinical care.3
IHI, in collaboration with many geriatricians and internists, has advocated and facilitated the adoption of Age Friendly Healthcare in many health systems across the country, spanning all clinical sites of care, including ambulatory, inpatient, post-acute, long term care clinical sites, as well as emergency departments. Through adoption of well-developed interdisciplinary care plans and implementation of the 4Ms principles in clinical care, IHI recognizes and designates health systems as Level 1 (participant teams who have succeeded in incorporating the 4Ms framework in their clinical sites of care) or Level 2 (teams committed to geriatric care excellence and have implemented the 4Ms care model for at least three months). Currently almost 3,000 healthcare institutions in the United States have Level 1 or Level 2 designations.3 Grants are available for health systems who wish to participate in some or all of the initiatives.4
In this theme issue, we explore the concept of Age Friendly Health Care, as well as its application in different clinical care settings and health systems. We also address key geriatric care topics pertinent to all clinicians who provide medical care for older adults including kidney disease in aging, deprescribing, screening and management of dementia with additional focus on new dementia treatments and their associated controversies. These first steps can move us towards what the John A. Hartford Foundation calls “patient priorities care”—promoting reduction of medications and unnecessary diagnostic testing and improvement of appreciation by patients and clinicians for attention to goals, reduced care burden, and improved quality of life.4