Applying the Age-Friendly Health Systems 4Ms framework to stroke care can improve outcomes and reduce harm for older adults by addressing their unique needs.
Applying the 4Ms framework to stroke care provides a comprehensive, evidence-based model to address the complex needs of older adults with stroke.
Background: America's aging population (nearly 17% of the U.S., projected to double by 2050) faces significant stroke burden; incidence doubles every decade after 55, with 75% of strokes in those over 65. This demographic also sees an increased prevalence of stroke risk factors (e.g. diabetes, hypertension, atrial fibrillation). Current healthcare systems often struggle with complex needs of older patients with stroke. The Age-Friendly Health Systems (AFHS) movement, developed by the John A. Hartford Foundation and IHI, aims to optimize outcomes, reduce harm, and improve patient experience. Purpose: To apply the AFHS 4Ms framework—What Matters, Medications, Mobility, and Mentation—to stroke care as a comprehensive approach for older adults with stroke. Methods: A scoping review of peer-reviewed literature from the past 10 years with search terms including combinations of “stroke,” “older adults,” and each of the 4Ms identified evidence-based practices. Articles were screened for relevance to geriatrics and AFHS 4Ms. Key stroke-related considerations were mapped to each of the 4Ms to inform development of a stroke-specific care model. Input from experts in geriatrics and neurology refined the framework. Results: The Age-Friendly Stroke Model applies each 4Ms component to stroke care. What Matters addresses acute treatment shared decision-making, goals of care, and time-limited trials. Medications encompass standard AFHS considerations (benzodiazepines, anticholinergics) and stroke-specific therapies (statins, anticoagulants, age-appropriate BP and HbA1c targets). Mobility emphasizes early in-hospital mobilization, rehabilitation planning, and care transitions. Mentation addresses delirium prevention/management, depression screening/treatment, and post-stroke cognitive impairment. Conclusions: The growing stroke burden in an aging population necessitates a fundamental shift in stroke care for older adults. The interplay between stroke and aging creates unique challenges directly aligning with the 4Ms. Systematic application of the 4Ms to stroke care offers an evidence-based approach to comprehensively address age-specific considerations, including subtle but critical differences in long-term management and prevention. This approach can improve outcomes, reduce harm, and ensure care aligns with older adults' individual goals, priorities, and complex needs. While designed for older adults, these principles may also extend to the broader stroke population.
Leonhardt-Caprio et al. (2026) studied this question. Applying the Age-Friendly Health Systems 4Ms framework to stroke care can improve outcomes and reduce harm for older adults by addressing their unique needs.