Bringing Age-Friendly Care to Dementia Support

Over 7 million older adults in the U.S. are currently living with dementia. In Washington state alone, there are over 127,000 people aged 65 and over living with Alzheimer’s and related dementias, with an annual cost of $747 million to Washington’s Medicaid program. There are about 255,000 friend and family caregivers providing much of the community care and support at an estimated value and benefit to Washington state of $11 billion annually. 

This raises a critical question: What are we doing and what more can we do?  

Washington’s Dementia Action Coalition is bringing awareness, education, and solutions. On the national front, the one thing we can do is to promote and provide age-friendly care. The John A. Hartford Foundation wanted to ensure a better way to meet the health care needs of older adults. They partnered with the Institute for Healthcare Improvement, the American Hospital Association, and the Catholic Health Association of the United States to develop and spread the adoption of better care. In 2016, an approach to age-friendly care was developed by enlisting national geriatrics-focused organizations, reviewing the literature, and generating a listing of proven geriatrics practices. Then, with a diverse group of national experts, they produced a concise and evidence-based approach to age-friendly care, termed the 4Ms framework: What Matters, Medication, Mentation and Mobility.  

Experts in the field of geriatrics, such as geriatricians, geriatrics nurses and social workers, are proficient in the care of older adults. The beauty of the 4Ms framework is that it brings evidence-based geriatrics practices to any professional discipline, direct care worker, community health worker, and friends and families who support and provide direct care. The 4Ms framework is spreading across the country, and as of June 2025, over 5,000 health care sites had adopted it.

One example is the case of a woman who cared for her spouse for months prior to his death. She reported using the 4Ms each day in his care. She asked him what mattered to him today and in the time to come, and ensured he took his meds as prescribed. She asked how he was feeling—content or sad, confused, depressed or clouded in thinking; and they discussed what activities he felt were possible and which activities brought him joy and comfort.   

In the same way, the 4Ms framework works very well for people living with dementia and their caregivers. And as age-friendly sites evolve their care, attention to how well the framework works for various conditions becomes apparent. For example, attention to the importance of caregivers is evident in the Centers for Medicare and Medicaid Services’ (CMS) Guiding an Improved Dementia Experience (GUIDE) model. The 4Ms approach to dementia fits perfectly with care navigation (what matters), further assessing and acting on medication needs, thinking and memory needs, and promoting optimal function.   

It is important to note that each person living with dementia has unique needs. This is why the 4Ms framework is beneficial. It is not a cookie-cutter approach, but an evidence-based framework that is designed to personalize care. Following the 4Ms is beneficial and distinctive for each person, starting with what matters. It uses simple and clear communication to assess:

• What is important today and what will matter in the future?
• Are medications supporting and improving quality of life, while maintaining a calm and predictable environment?
• How is the patient’s mood and thinking today?
• Is current daily activity enough?
• What more can be done to support optimal function while encouraging participation in familiar activities that promote independence and dignity?

I challenge each of us to use the 4Ms in our daily life and work and see for ourselves how well it can prepare us to bring age-friendly and dementia-friendly care to our families and communities. For more information, visit: https://www.ihi.org/partner/initiatives/age-friendly-health-systems

Jane Carmody, DNP, MBA, RN, FAAN is a senior program officer at The John A. Hartford Foundation, a national private foundation dedicated to improving the care of older adults.