Age-Friendly Health Systems Research Articles on Medication
Age-friendly care is health care that addresses our unique needs and can help us enjoy a better quality of life as we get older. There is a growing body of evidence about the Age-Friendly Health Systems 4Ms Framework, including Medication.
The 3rd “M”, Medication, of the 4Ms Framework for age-friendly care encourages older adults and their health care teams to review all their medications (including over-the-counter medicines and supplements), their side effects and how they may interact with each other. Age-friendly approaches to medication helps address the other “Ms,” what Matters, Mentation and Mobility.
Journal articles about age-friendly approaches to medication include:
American Journal of Nursing: Optimizing Older Adults' Medication Use
Many older adults have multiple chronic conditions that require complex medication regimens. Consequently, 50% of family caregivers report direct involvement with medication administration in the home, but with minimal support. Given that many caregivers are older adults themselves, managing these complex regimens can be difficult and stressful. This article, the third in a series on the 4Ms, presents strategies for assessing and acting on hospitalized older adults' medications in partnership with family caregivers, tips to help caregivers manage medications at home, and resources for clinicians and caregivers.
Journal of the American Geriatrics Society: Safer Prescribing for Hospitalized Older Adults with an Electronic Health Records-Based Prescribing Context
Hospitalized older adults are at risk of receiving potentially inappropriate medication (PIM) doses, driven in part by age-independent dose defaults used by electronic health records (EHRs), leading providers to prescribe for older adults as they do for younger adults. The researchers studied whether an automated EHR-based medication support tool called the Geriatric Prescribing Context (GPC) would reduce PIM dosing for hospitalized older adults. They found that use of recommended geriatric doses with the context improved for all 10 of the most commonly ordered medications. In the year after implementation, there was a trend toward decreasing TDD and AD across all drug classes. The conclusion noted that, "The GPC is a simple, elegant, and effective means to align prescribing practices with safety standards for older adults, improving prescribing safety for all. It works within the current prescriber workflow without triggering alert fatigue and requires minimal resources for development and maintenance." On the ground use of the GPC is described in an Institute for Healthcare Improvement blog, One Size Does Not Fit All - Improving Geriatric Prescribing.
Journal of Gerontological Nursing: An Interdisciplinary Approach to Implementing the Age-Friendly Health System 4Ms in an Ambulatory Clinical Pathway With a Focus on Medication Safety
A quality improvement project was conducted at the MedStar's Center for Successful Aging (CSA) to integrate the Age-Friendly Health Systems' 4Ms framework into the CSA ambulatory clinical pathway. Their interventions found upward trends in patients receiving 4Ms care during their new patient visits. Positive preliminary feedback was also obtained from providers following the incorporation of the 4Ms framework in the high-risk rounds discussion. A focus on high-risk medications and deprescribing illustrated positive clinical outcomes. This ongoing interprofessional collaboration illustrates the importance of person-centered care and quality improvement to achieve Age-Friendly Health Systems status within an ambulatory practice.
International Journal of General Medicine: Deprescribing in the Older Patient - A Narrative Review of Challenges and Solutions
Polypharmacy is a major challenge in healthcare for older people, and is associated with increased risks of adverse outcomes, such as delirium, falls, frailty, cognitive impairment and hospitalization. There is significant public and professional interest in the role of deprescribing in reducing medication-related harms in older people. The authors aim to provide a narrative review of 1) the safety and efficacy of deprescribing interventions, 2) the challenges and solutions of deprescribing research and implementation in clinical practice, and 3) the benefits of using Computerized Clinical Decision Support Systems (CCDSS) and Quality Indicators (QIs) in deprescribing research and practice.
Learn more about IHI's AFHS initiative.
Learn more about the 4Ms of Age-Friendly Care.
Learn more about JAHF's support of the AFHS initiative.
