Becoming an Age-Friendly Health System (AFHS) means using the evidence-based 4Ms Framework: ‘What Matters’, ‘Medications’, ‘Mind’ and ‘Mobility’ – to provide efficient, appropriate and high-quality care for every older adult. The AFHS blueprint sets out an ambitious plan to become a country where the entire health system is designed and delivered through an age-friendly lens, to support longer lives by integrated, person-centred, high-quality care. The framework has been developed on a collaborative basis across the Department of Health, HSE, and frontline staff, integrating clinical expertise with the preferences and will of older adults.

The AFHS is aiming to better simplify the complexities of care for older adults and organises care to focus on their wellness and strengths. The 4Ms framework does not replace existing models of care or care pathways. The intention is to incorporate the 4Ms framework into existing care across all settings, rather than adding another layer of complexity. By consistently integrating the ‘4Ms’ framework, significant positive outcomes are anticipated, including:

• Improved patient outcomes and experiences of care
• A reduction in Emergency Department (ED) attendance and readmissions
• Reduced Length of Stay (LoS) in hospitals
• Decreases in polypharmacy and adverse drug events
• More cost-effective, efficient, and integrated care pathways

Work has already commenced to evaluate these principles across the health system. In 2021, Cork University Hospital (CUH) became the first site in Europe to receive formal recognition as an Age-Friendly Health System by the Institute for Healthcare Improvement (IHI).

Building on this foundation, the HSE South-West is advancing a proof of concept to establish Ireland’s first Age-Friendly Health region, with early progress adopting the ‘4Ms’ Framework across acute, rehabilitation, residential, and community services. 

Notes
The 4Ms Framework
The ‘4Ms’ Framework simplifies the complexities of care for older adults and organises care to focus on their wellness and strengths. The intention is to incorporate the ‘4Ms’ into existing care across all settings, rather than adding another layer of complexity.

The 4Ms are:
What Matters: We must understand what matters most to each older adult, ensuring care aligns with their will and preferences, and aligning care decisions with the older adult’s priorities and goals, not just their diseases.

Medication: We must prescribe medication thoughtfully and safely, choosing medications that benefit 'What Matters', Mind, and Mobility. The objective is to eliminate unnecessary, ineffective, and duplicate medications.

Mind: We must support a healthy mind and emotional wellbeing by the prevention, early recognition, and treatment of delirium, dementia, and depression.

Mobility: We must support older adults to live, thrive, and do ‘What Matters’ most to them, ensuring early, frequent, and safe mobility to maintain function

Actions and Progress
Work has already commenced to evaluate these principles across the health system. In 2021, Cork University Hospital (CUH) became the first site in Europe to receive formal recognition as an Age-Friendly Health System by the Institute for Healthcare Improvement (IHI). Building on this foundation, the HSE South-West is advancing a proof of concept to establish Ireland’s first Age-Friendly Health region, with early progress adopting the 4Ms Framework across acute, rehabilitation, residential, and community services.

Delivering Timely and Integrated Care
The AFHS approach builds on the core objective of Sláintecare to deliver timely, high-quality, person-centred, integrated care at the lowest level of complexity, supporting older people to age well in place. Older adults are recognised as having unique and specific care needs, requiring bespoke assessments and treatments. Older adults are the highest per capita users of healthcare services. They attend their GP an average of 8 times a year, and 90% of those attending Emergency Departments are triaged as needing immediate and urgent care. Furthermore, older adults utilize 57% of acute hospital bed days and use most of the 26.7 million hours of home support provided annually.

Expected Impacts and Cultural Change
By consistently integrating the 4Ms, significant positive outcomes are anticipated:

• Improved patient outcomes and experiences of care.
• A reduction in Emergency Department (ED) attendance and readmissions.
• Reduced Length of Stay (LoS) in hospitals.
• Decreases in polypharmacy and adverse drug events.
• More cost-effective, efficient, and integrated care pathways.

The launch event included presentations from international experts, including Mr Pedro Delgado, Vice President of the Institute for Healthcare Improvement (IHI), and Regius Professor Rose-Anne Kenny and Professor Cathal McCrory from TILDA, TCD, whose Wave 6 Report provides the evidence base for adopting the 4Ms nationally.

The blueprint aligns with the Sláintecare reform of the health and social care system.