| Description |
The rapidly growing older adult population of the United States creates unique health care challenges. By 2060, demographers anticipate a near doubling of the over 65 cohort (Mather, 2019). Utah's latest census measures the over 65 population at 11.4%, about 365,000 people, with a seminal increase projected by 2030 when all baby boomers will have reached their 65th year (Hollingshaus, 2018; United States Census Bureau, 2019). Policy projections define Utah's unique position: the sixth fastest growing aging population in the nation with the over 85 population projected to increase more than 100 percent from 2000-2030 (Center for Public Policy and Administration, n.d.). Chronic disease is also on the rise. According to the National Council on Aging (2012), 71 percent of adults have multiple chronic diseases. Frailty and pressing social determinants often compound multiple chronic conditions in older adults (Mate et al., 2018). These factors create complex care needs that current health care systems are poorly prepared to meet, placingolder adults at disproportionate risk of harm (Institute for Healthcare Improvement, 2020). To address this burgeoning need, the John A Hartford Foundation and the Institute for Healthcare Improvement (IHI) joined forces with the American Hospital Association and the Catholic Health Association of the United States to formulate a well-researched care delivery model for older adults: An Age- Friendly Health System (Mate et al., 2018). Age-friendly systems avoid both harm and unnecessary care. Their aim is an adaptation of this model in 20 percent of healthcare systems by 2020 (Health Resources and Services Administration, 2018). The Age-Friendly Health System is a framework that envisions an evidence-based geriatric care model applicable across the care continuum and adaptable to all types of healthcare systems (Capezuti & Brush, 2018). IHI (2020) shares that the consortium sought an evidence-based c are model that could also "decrease harm" and align " with what matters most to the older adult and their family caregivers" (p.4). Through research and a review of existing care models, key principles of best geriatric care were identified, known as the 4M's: what Matters to the patient, Medications, Mentation, and Mobility (IHI, 2020). The John A Hartford Foundation notes that older adults routinely lack necessary evidence-based care, receive unwanted care, and face disproportionate harm from inappropriate medications, mobility-neglected functional declines, and avoidable delirium /cognitive decline (Health Resources and Services Administration, 2018). They also encounter higher proportions of iatrogenic harm, such as infections or adverse drug effects, and death (Health Resources and Services Administration, 2018). The 4M framework addresses each of these care gaps guiding systems to higher value geriatric care (Health Resources and Services Administration, 2018). The Health Resources and Services Administration (HRSA) is a federal agency with oversight for improved healthcare delivery and healthcare workforce training (HRSA, 2021). HRSA (2021) awards the bulk of its budget as grants and administers a Geriatric Workforce Enhancement Program (GWEP) to improve the care of older adults and embed geriatrics in primary care (HRSA, n.d.). The Utah Geriatric Education Consortium (UGEC) is the recipient of GWEP funding to improve geriatric healthcare delivery by implementing the 4M framework in an ambulatory care system (Utah Geriatric Education Consortium, 2020). As a requirement of the grant, Merit -Based Incentive Payment System (MIPS) measures, a Center of Medicare and Medicaid Services payment program, will be collected to evaluate the intervention'seffectiveness (Center for Medicare and Medicaid Serivces [CMS], n.d.). |
