Transforming Health Care for Older Adults

Age-Friendly Health Systems (AFHS) logo.

To ensure older adults receive safe, evidence-based care focused on what matters to them, the AHA is working with partners and care teams as part of the Age-Friendly Health Systems movement.

Today, more than 3,000 care sites, including hospitals and health systems, ambulatory care, long-term care and post-acute care, have been recognized as Age-Friendly Health Systems.

Why become an Age-Friendly Health System?

  • Age-friendly health care is an urgent need. There are more than 54 million Americans age 65 or over, and that number is projected to climb to about 95 million by 2060.
  • Many older adults have more than one chronic disease and take multiple medications. Many individuals in this population of people live with uncertainty as they transition from living independently to reliance on others.
  • Delivering care based on the 4Ms Framework — what matters, medications, mentation and mobility — helps reduce readmissions, decrease length of stay and improve health outcomes for older adults

Age-Friendly Health Systems is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) in partnership with the American Hospital Association and the Catholic Health Association of the United States (CHA).This work is part of the AHA’s commitment to advancing health of all individuals at every life stage in communities across the country.


Enhancing Care for Older Patients with Age-Friendly Health Systems

Sonja Rosen 

Sonja Rosen, M.D., chief of geriatrics at Cedars-Sinai, shares updates on the organization’s journey as an Age-Friendly Health System and describes a multidisciplinary approach to providing quality care for older patients amid workforce challenges. Rosen also discusses working with community partners to improve the health and well-being of older adult patients.

Improving Older Adult Care in the Geriatric Emergency Department

Kevin Biese 

Kevin Biese, M.D., co-director of the division of geriatric emergency medicine at University of North Carolina Hospitals, talks about processes, education and community connections that help ensure older adults admitted to hospital EDs receive quality, patient-centered care.


The “4Ms” Framework

  • What Matters: Know and align care with each older adult’s specific health outcome goals and care preferences including, but not limited to, end-of-life care, and across settings of care.
  • Medications: If medications are necessary, use age-friendly medications that do not interfere with What Matters, Mentation or Mobility.
  • Mentation: Prevent, identify, treat and manage depression, dementia and delirium across settings of care.
  • Mobility: Ensure that older adults move safely every day in order to maintain function and do What Matters.

An Age-Friendly Health System is one in which every older adult’s care:

  • Is guided by an essential set of evidence-based practices (the 4Ms);
  • Causes no harms; and
  • Is consistent with What Matters to the older adult and their family.

Additional information and resources about the Age Friendly Health Systems Initiative and 4Ms Framework can be found at Institute for Healthcare Improvement.


the AHA Action Community

The AHA is currently recruiting for its fifth Age-Friendly Health Systems Action Community convening September 2023, with acute, post-acute and outpatient sites of care. Age-Friendly Health Systems action communities, led by AHA and IHI, test the 4Ms Framework in hospital and ambulatory settings, sharing learnings in a seven-month virtual community.

The benefits of the Action Community include:

  • Redeploying and prioritizing existing hospital/health system resources.
  • Supporting your health organization’s mission, vision and values.
  • Putting your organization ahead of the curve in preparing for the impending market shift.
  • Achieving “Age-Friendly Health Systems Participant” or "Committed to Care Excellence" recognition.
Group of people

View more information about how you can participate by visiting IHI's Age-Friendly webpage. Email for additional information or to ask questions.


Since the first AHA Age-Friendly cohort launched in 2019, AHA Age-Friendly Health Systems Action Community participants have implemented the 4Ms Framework across a variety of care settings.

  • "Age-Friendly Health Systems Participants" are hospitals and health care practices that have developed an action plan to showcase their commitment to putting the 4Ms into practice.
  • "Age-Friendly Health Systems – Committed to Care Excellence" have submitted counts of older adults reached with the 4Ms for at least three months.

Visit the Institute for Healthcare Improvement's website for a complete list of hospitals and practices recognized by the Age-Friendly movement.

Interactive map: See age-friendly-designated health care organizations across the U.S.



Case Study

Person in hopital bed with child near

Integrating Age-Friendly Care in a Hospital ED

A multidisciplinary team at Sharp Grossmont Hospital works to ensure adults age 65 and older get quality emergency care, with positive results for patients and caregivers.


Rick Pollack

AHA President on Transforming Health Care for Older Adults

AHA President and CEO Rick Pollack highlights how the Age-Friendly Health Systems movement is advancing the health of older adults.

Chair File

AHA Board Chair John Haupert

AHA Board Chair on Urgent Need for Age-Friendly Care

In this column, AHA Board Chair John Haupert discusses how the Age-Friendly Health Systems movement supports older adults and their care teams.

Case Study

Medical staff with a patient, St. John - Riverside Hospital

Making Age-Friendly Care a Mission Goal

St. John’s Riverside Hospital created a data hub for all clinical teams, part of its efforts to integrate age-friendly care strategies across the organization.

Case Study

Task force from AdventHealth Hendersonville

A Communitywide Approach for Age-Friendly Care

The age-friendly task force at AdventHealth Hendersonville created a vision board that helps drive improvements in caring for older adult patients.

Case Study

St. James Parish Hospital

Age-Friendly Care At a Critical Access Hospital

Despite limited resources and staff, St. James Parish Hospital used the 4Ms framework and successfully implemented and spread age-friendly concepts.

Case Study

Older person looking at video call

Embedding an Age-Friendly Framework Into Practice

Banner Health used the 4Ms framework in caring for high-risk, older adult patients, which improved patient and provider satisfaction scores.

Case Study

Two people looking at a document

Age-Friendly Health Care Improves Value for Patients

This case study describes how a Cedars-Sinai Medical Center team used the 4Ms framework to reduce length of stay and improve outcomes for geriatric fracture patients.

Case Study

Becoming an Age-Friendly Health Care System

A member of Care New England, Kent Hospital opened an Adult Care for Elders unit to test the 4Ms Framework. Length of stay has decreased, and patient satisfaction has increased.

Case Study

Building an Age-Friendly Health System and Community

Rush University Health System began implementing the 4Ms Framework to improve the lives of patients, families, caregivers and employees.

Issue brief

Creating Value with Age-Friendly Health Systems

This Value Initiative issue brief highlights the 4Ms as a low-tech, value-based strategy to improve patient outcomes and experience for older adults.


Success Story: Implementing the 4Ms at Christiana Care

Nurses and other key stakeholders at Christiana Care embraced the 4Ms Framework, which became part of strategic planning efforts.


Putting the 4Ms into Practice

Learn more about the 4Ms Framework and how to use it in practice to become an Age-Friendly Health System in the Guide to Using the 4Ms in the Care of Older Adults.


Making Care Better and Friendlier for Older Adults

Personal story about caring for aging parents shared by Marie Cleary-Fishman, vice president of clinical quality at the AHA Center for Health Innovation.



4Ms Framework for an Age-Friendly Health System

Rush Center for Excellence in Aging highlights using the 4Ms to create an Age-Friendly Health System.

What Is an Age-Friendly Health System?

Mary Tinetti, M.D., chief of geriatrics at Yale School of Medicine and Yale–New Haven Hospital, describes what it means to be an Age-Friendly Health System.

How the 4Ms Improve Care for Older Adults

This video from the John A. Hartford Foundation outlines how to provide the best care possible for older adults.



The John A. Hartford Foundation
The Institute for Healthcare Improvement (IHI)
Catholic health ministry of the United States
Age Friendly Logo