Age friendly – locally and nationally (Dementia) BOLD GRANT WA DAC, August 18, 2025

Draft: Age friendly – locally and nationally (Dementia) BOLD GRANT WA DAC, August 18, 2025

JCarmody and interns

I had the great privilege of working collaboratively with Jane Carmody on emergency preparedness with the Department of Health and King County Community and Human Services Department of Community 2 years ago, and then I met her in person at the Dementia Provider Summit in March 2025. We’ve discussed a follow-up article to dementia care, and she kindly, with the assistance of interns offered this article about dementia.

Over 7 million older adults in the US 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 to an annual cost of $747 million to Washington State Medicaid. Also, 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?  Certainly, Washington State’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 healthcare needs of older adults and partnered with the Institute for Healthcare Improvement, the American Hospital Association, and the Catholic Health Association of the United States, to develop and spread adoption of better care, age-friendly care. In 2016, 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 produced a concise, meaningful and evidence-based approach, termed the 4M’s framework: What Matters, Medication, Mentation and Mobility.  

Experts in the field of geriatrics, such as geriatricians, geriatrics nurses and social workers, are proficient in care of older adults. So, 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 for the friends and families supporting and providing direct care. The 4Ms framework is spreading across the country and as of June 2025, over 5,000 healthcare sites have adopted the 4Ms age-friendly care.

The 4Ms, as a set, works for any condition, and definitely supports a dementia-friendly care approach.  An example of how the 4Ms can be used by anyone comes to mind. A nonclinical person, cared for her spouse for months prior to his death. She reported using the 4Ms each day in his care: asking what mattered to him today and in the time to come; ensuring meds were taken as prescribed; how was he feeling, content or sad, was he confused, depressed or clouded in thinking; and what was possible for activity and what activity brings 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, not any one is the same and this is why the 4Ms framework is beneficial, 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, using simple and clear communication assessing 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 mood and thinking today; and, is current daily activity enough and what more can be done to support optimal function with encouraging participation in familiar activities to promote independence and dignity.

I challenge each of us to use the 4Ms in our daily life and work and see for ourselves how effective the set (4Ms together) proves to be so we will be better prepared 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

Credit to Jane Carmody DNP, MBA, RN, FAAN, Senior Program Officer, The John A. Hartford Foundation for the writing of this article.