Ugochi Ohuabunwa is medical director of the Acute Care for the Elderly Unit and chief of the geriatrics service line at Grady Memorial Hospital in Atlanta. Grady is an “age-friendly health system,” meaning the hospital provides four evidence-based elements of high-quality care to patients 65 and older.
“We make sure every member of our health care team is skilled in elder care, all working with the patient to reduce functional decline and improve overall outcomes,” says Ohuabunwa. “What are the measures you can put in place across the system to improve outcomes for older adults? The 4Ms.”
1. What Matters
Know what each older adult’s specific health outcome desires are and align care acccordingly. “We’re not talking just about end goals but what their goals are on a daily basis They are a part of deciding what they want to do, what is most meaningful and important to them.”
2. Medication
When drug therapy is necessary, use age-friendly medications that do not interfere with other priorities. “We flag high-risk medications that might cause, for example, a fall or delirium, and a pharmacist gives feedback to our teams. Would you consider other alternatives? The goal of geriatrics is to use low-risk, high-benefit medicines unless there is no option.”
3. Mentation
Protect older adults’ brain health and mental health by preventing, identifying, treating, and managing dementia, depression, and delirium across all settings of care. “We incorporate screening tools, and every 12 hours our teams report on the mood of the patient. We also offer activities that are preventive or therapeutic for mental health and brain acuity. Medical students will come out on the weekends and spend time with the patients who are high risk.”
4. Mobility
Ensure that older adults move safely every day so they can maintain function and meet their “What Matters” goals. “They tell us what they want to do for the day, but our medical team also tells them what activities should be done. We focus on both short-term and long-term goals.
ILLUSTRATIONS GETTY FEODORA CHIOSEA
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