As the older adult population continues to age, communities are tasked with supporting the physical and mental health needs of older adults, at times, leaving health systems unprepared to provide the necessary care to meet their complex needs. Recognizing this, Advocate Aurora Health (AAH) set out to become an Age-Friendly Health System, defined as one in which every older adult gets the best care possible, experiences no health care-related harms and is satisfied with the health care they receive. The Age-Friendly Health System provides a framework of four evidence-based elements of high-quality care, the “4Ms”—What Matters, Medication, Mentation and Mobility—to improve patient outcomes.


Aging increases the risk of chronic diseases and comorbidities. Over 50% of hospitalized patients in AAH are older adults; therefore, it is AAH’s commitment to provide excellent clinical care for older adults. 

AAH’s age-friendly implementation began with a small test of change in the clinic setting with senior resource nurses. Leadership support in the clinic helped with the ability to pull the nurses from the frontline so they could attend to the work in the Action Communities, while IT resources were offered to standardize the nurses’ patient assessment. The team also included a patient to account for the voice of patients and families, as reality checks. The team used the Plan, Do, Study, Act (PDSA) model for improvement to ensure consistent implementation of the 4Ms was assessed weekly.   

Advocate Aurora’s health at home also implemented the age-friendly 4Ms in their “perfect patient visit” and standardized documentation with the visit template. Orientation for new team members included age-friendly 4Ms, and quality PDSAs were performed through review of the patient electronic medical record. 

With the successes of the clinic and home care pilot program, AAH identified additional pilot sites at five hospitals that will be the first to go through the Institute for Healthcare Improvement’s Action Community and implement the 4Ms at their sites. These sites will set the standards for age-friendly implementation for the entire AAH system across Wisconsin and Illinois. The goal is to have all sites designated as age-friendly by the end of 2024. A system data dashboard is in the works that will include process documentation of the 4Ms. 

AAH had to pause its age-friendly implementation during the recent surges of COVD-19, which has halted full implementation efforts and data collection. Even with this pause, the sites have continued to educate staff how to assess and act on the 4Ms in real time. Even though full-scale implementation is still on the horizon, the culture change happening in the units that are educating on the 4Ms is demonstrating decreases in sitter usage, Beers medications administered, delirium rates and falls.

Moving forward, AAH will identify age-friendly champions/teams at each site of care. These champions will lead the age-friendly efforts at the site, and they will become the “expert” to guide all units/clinics on the implementation of 4Ms care across the care continuum. As system co-leads to provide ongoing support to teams, they will hold collaborative meetings monthly to support teams throughout the system. One collaborative will be with units/sites that have already implemented and achieved age-friendly designation that will work on quality improvement and maintenance efforts. The second collaborative will be for sites that are going through the IHI Action Community and working on implementation efforts. 

AAH is also creating an AAH age-friendly guide to assist teams in their implementation efforts and is creating education models specific to implementation of each of the 4Ms to be used systemwide. Quality improvement efforts utilizing the 4Ms will help AAH improve its older adult patient experience scores and expand upon its diversity, equity and inclusion efforts. 

AAH Lessons Learned:

• Just as in any journey, you need a compass to guide your way. AAH engaged executive and system leaders to set the direction and support the efforts.
• “What matters” should be asked of our patients, team members and leaders—this will allow you to gain perspective and to stay true to the focus of the effort.
• Work smarter, not harder. Partner with the experts, engage in the IHI Action Communities and utilize all the tools that have been created. 
• This is an interdisciplinary effort, and it is important to have the right people at the table, including patients, front line staff and leaders of various roles and settings. This allows you to leverage vast expertise and insight to each of the 4Ms. 
• Leads at system level are vital, and they will drive the efforts. Having champion leaders at the site is essential, and they are the fuel needed to implement the effort. Engaging innovators and early adaptors will lead culture change.
• These efforts should be done in the spirit of learning and improvement. Complete PDSA cycles to learn, adjust and make improvements along the way.
• Align this work with programs/processes that are already in place. Stress to teams that this is not adding anything to their plate; rather, it is improving on and getting credit for work that is already done. Demonstrate how Age-Friendly Health System program aligns with current efforts and shared goals.