The 4Ms of Care for Older Adults

The United States is aging. The number of older adults, individuals ages 65 years and older, is growing rapidly. As we age, care often becomes more complex. ChristianaCare is using innovative strategies to make the complex care of older adults more manageable, safe and attuned to patients’ needs and goals.

Targeting the specific needs of older adults

The 4Ms are a framework for managing the unique health challenges and needs of older adults.

They were developed as part of an Age-Friendly Health Systems initiative led by The John H. Hartford Foundation and the Institute for Healthcare Improvement in partnership with the American Hospital Association and the Catholic Health Association of the United States.

ChristianaCare is an early adopter of the 4Ms framework. The goal is to have 20% or more of U.S. hospitals and medical practices using the 4Ms framework in 2020.

What are the 4Ms?

ChristianaCare is an early adopter of the evidence-based 4Ms approach, designed to give older patients the best care possible in the ways that are important to them.

  • What Matters Most: This involves knowing and aligning care with each older adult’s specific health outcome goals and care preferences. Examples include staying active, participating in special events with the family and traveling.
  • Mobility: This can include working with your care team to continue to participate in social, cultural and physical activities that are meaningful and make you feel connected to the community. To help encourage our patients to move each day while they are in the hospital, ChristianaCare is piloting an initiative called Activity and Mobility Promotion. This program features a daily mobility calculator that can determine your optimal movement goals and chart your improvements.
  • Mentation (or the Mind) addresses critical problems like dementia, delirium, and depression. Proper diagnosis and treatment can make a significant difference in quality of life.
  • Medications should not interfere with What Matters to you, Mobility, or Mentation. This involves raising awareness about potential side effects and reducing the number of medications you take whenever possible.

A national leader in the care of older adults

ChristianaCare is a recognized leader caring for an aging population as an IHI Exemplar Age-Friendly Health System.

ChristianaCare has earned Exemplar status for eight consecutive years under the national NICHE (Nurses Improving Care for Healthsystem Elders) program. ChristianaCare is the only hospital in Delaware to achieve the award and one of only 82 NICHE sites nationwide.

ChristianaCare’s We Improve Senior Health (WISH) program brings together medical professionals including physicians, nurses and rehabilitation therapists and connects them to pharmacists, social workers and others who affect patients’ well being to better coordinate services among those responsible for seniors’ health.

These programs are part of ChristianaCare’s commitment to being exceptional today and even better tomorrow as partners in the health of our community.

Interested in learning more about the 4Ms? Contact me at or 302-733-5338.

Denise Lyons, DNP, APRN, is manager of the WISH program at ChristianaCare.