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Why the 4Ms Framework should matter to you

Published 05/04/2022

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A simple but powerful framework, the 4Ms (what matters, medication, mind and mobility) organises complex care for older people based on what’s important to them.

The 4Ms are the foundation of Age-Friendly care, which is an evidence-based, person-centred approach. It has been shown to improve care and reduce harm for older people in health care settings.

The Australian population is ageing rapidly, and as we age, our care often becomes more complex. Older people are more likely to suffer harm such as falls, physical deterioration, medication errors, infections or confusion in a healthcare setting.

Implementing the 4Ms helps organise the complexity of older people’s care, benefitting them, their carers, family, and health service staff.

“Asking what matters promotes a more person-centred approach to care.  We’re already hearing anecdotes about how the framework is improving quality of life for older people in our health systems.”

Jen Thompson, Senior Project Officer - Age-Friendly Health Systems

The 4Ms framework already has a proven track record. The approach has been successfully implemented in over 2,000 clinical sites across the United States, with improved outcomes including reduced length of stay, reduced readmission rates and fewer falls.

The 4Ms focus on an older person’s wellness and strengths rather than their health conditions. It’s an accessible approach that works regardless of the health profile or social or cultural background.

‘What matters’ is the cornerstone of the 4Ms. Decisions surrounding medication, mind and mobility should link back to this to support what’s important for the older person and their quality of life. 

“Applying the 4Ms is supporting a holistic approach to care. Previously staff would operate within their clinical confidence areas, now we are encouraged to look at the person and what they value and need. We’re working towards delivering 4Ms care for each older person as one team.”

Pete Grey, Ballarat Health Services (part of Grampians Health)

Many health services already practise two or three of the 4Ms. However the key to successfully implementing the 4Ms is to practise them together. It’s also vital to apply them reliably – for all older people, in all settings, and in every interaction. 

So how does a ‘what matters’ conversation work?

'What matters’ conversations gives older people opportunities to discuss how they want to manage their health and care preferences.

It’s a shared decision-making tool between the older person and a healthcare provider, where family and friends can be included in the conversation supporting the older person to identify and articulate their needs.

"Having a simple conversation opened the door for a whole range of changes. Some were just small things, and we wondered why we hadn’t thought of them already."

Kate Jones, Registered Nurse

A health service might work collaboratively with an older person to support them to take their medication at the right time during the day, provide assistance to go for a daily walk, or supplying preferred food or snacks. 

The Age-Friendly Health Systems in Victoria initiative will co-design, test and refine the 4Ms framework, improving outcomes for older adults in partnership with the Institute for Healthcare Improvement (IHI).

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