How to incorporate an age-friendly model into your practice

This article explores age-friendly health service models of care and how allied health professionals can contribute to facilitating age-friendly health practice.

 

In this article I will focus on:

• What is an age-friendly health service model
• Why is it important to consider this type of health care
• What can allied health professionals do to incorporate an age-friendly model into their every day practice.

 

Allied health services are provided across a broad range of settings within Australia, including inpatient and outpatient hospital settings, community health centres and the private sector. All these settings regularly engage with older people and as such allied health practitioners  have a role to play in ensuring that the services that they provide are age friendly.

 

What is an age-friendly health service model?

Now that the Covid pandemic lockdowns are behind us, we need to keep reflecting on this question:  ‘How can we reintroduce care differently, instead of just carrying on with business as usual?’

 

An age friendly health system is based on the 4M’s international framework that is evidence-based and is designed to prevent decline, while maintaining or improving the health and wellbeing or older people who are accessing health services.

 

The Institute for Healthcare Improvement describes the 4Ms as a framework or model of care that is not designed to be an addition to the care that is already being provided, but rather enables health professionals to consider whether are they incorporating all the essential areas of care to improve health outcomes for older people.

 

The four elements to this framework include:

• What matters:
  • Know what matters to the older person, what are their health outcome goals and care preferences for current and future care
• Medications:
  • Consider standard process for age friendly medication reconciliation and instigate de-prescribing or adjust doses to be age friendly
• Mobility:
  • Implement an individualised mobility plan and create an environment that enables mobility
• Mind:
  • Consider whether the older person has adequate nutrition, hydration, sleep and comfort and engage with them to maximise independence and dignity
  • Identify, treat and manage dementia, delirium and depression.

 

Why is it important to consider this type of health care?

Health services need to be orientated towards the needs of older people rather than on the focus of health service themselves. Within the busy-ness of the clinical day and the competing challenges of providing quality and safe healthcare balanced by financial and time pressures, it is important to remember that active listening matters.

 

Older people often talk about negative experiences when engaging with health professionals, such as ageism translating into sometimes insensitive or dismissive comments or management approaches. Hurried through appointments with distracted health professionals without having a chance to or feeling empowered to ask questions is also commonly highlighted. Some older people often feel that their health concerns are just dismissed or put down to old age without consideration of underlying pathology.

 

….he said, “I am the health professional here and I will tell you what is wrong with you” (older Australian person)

“Just a look on the health professionals’ face, you don’t want to ask questions” (Cheryl, 76 year old retired teacher)

 

Positive encounters can be deeply gratifying for both parties by building trust and rapport.

 

“The health professionals were sincerely concerned about my well-being….They behaved as if, at that very moment, I was their only patient” (Marian, 72 year old former pilot and police trainer)

“She listens; she treats me as an equal…we discuss things and she gives me choices”

 

What can allied health professionals do to incorporate an age-friendly model into their everyday practice?

While as podiatrists we aren’t always able to provide all aspects of the 4M framework, we can recognise and respond to these elements by actively engaging in conversation with our older clients and facilitating appropriate referral pathways where necessary.

 

What matters:

• Consider how we engage with older people, including the language we use, as well as how other staff interact within our practices/organisations and embed regular health questioning on what matters to them.

 

Medications:

• Keep up to date with the medications that our older clients are taking and be proactive in referring on for medication reviews if you consider there are issues or changes need to be made.

 

Mobility:

• For all older clients consider incorporating a mobility plan, work with them to achieve their goals and regularly review how they are going.

 

Mind:

• You should be regularly questioning older clients on their overall health and wellbeing, including mental wellbeing and actively instigating referral pathways when you identify areas that would benefit additional support or review.

 

Other key things to consider include:

• Undertaking a comprehensive assessment to ensure you are considering the whole person
• Having shared common care and treatment goals across different health providers.
• Understanding what services are available in the local area to support older people so effective referral pathways can be instigated.
• Tailoring management strategies to incorporate self-management approaches.
• Regularly reviewing the goals and outcomes that have been implemented.
• Having ongoing conversations on what matters to the older person and what support they need using the 4M model approach.

 

The end goal

Working together with older people to identify and understand their needs, expectations, values and preferences is critically important given our ageing population and the complexity of health care needs older people present with. As allied health professionals we should be responsive to the needs of our older clients and ensure that we are incorporating the spirit of an age friendly health service model into every encounter we have.

 

More information

• Towards age-friendly primary health care. World Health Organisation (2004)
• Age-Friendly Health systems: Guide to using the 4M’s in the Care of Older Adults. Institute of Healthcare Improvements (2020)