Application of the Age-Friendly 4M’s Movement Across Different Areas of Pharmacy

The health care system faces many challenges, but one that has grown in recent years with an increasing aging population is the need to deliver care that meets the needs of older adults. One initiative that emerged 8 years ago is the Age-Friendly 4M’s framework, a model championed by The John A. Hartford Foundation and The Institute for Healthcare Improvement (IHI).¹

Age-friendly care refers to addressing unique needs and key considerations with aging.² Some pharmacy practice settings have started to adopt this care model, including hospitals, long-term care facilities, and community pharmacies, though the principles involved can be applicable to many other areas across the profession.

Understanding the 4M’s and Relation to Pharmacy

Each component of the 4M’s movement is essential in providing safe and effective age-friendly care.

The first component is “what Matters.” This question identifies individual goals and preferences (including medication use) that providers should ensure are implemented in all care plans.² For example, a patient may reveal that active engagement with their grandchildren is the most important thing; this should drive decision-making and health care approaches for the patient.

Another component is “Medication.” This is the most traditional pharmacy concept, and recognizes that age-related physiologic changes impact the body’s interaction with medication along with the need for regular evaluation of each medication for need, efficacy, and safety.^2,3 It should also pay particular (but not exclusive) attention to high-risk and potentially inappropriate medications, with consideration of the effect toward the other 4M components for a patient.^2,3

The third component is “Mentation,” including both mind and mood. This component addresses care and screening for dementia, depression, or delirium.²

The final component is “Mobility,” where goals are determined according to the patient’s desired activities and by what matters with attention to safety and support to promote independence and function for as long as possible.²

The 4Ms are not mutually exclusive; each component can and does impact the other 3. Medications that cause dizziness increase fall risk and therefore impact mobility. A decrease in mobility may subsequently influence mentation and have a negative effect on what matters. A patient with unrecognized dementia may not appropriately understand medication counseling and become nonadherent or take their medications inappropriately. Patients with mobility issues may not be able to get to the pharmacy to obtain medications that help them address what matters. These are a few examples of the limitless possibilities where health care professionals should be mindful.

Patient care in most pharmacy practice settings would and does benefit from implementing the age-friendly care model. In 2025, the Centers for Medicare and Medicaid Services (CMS) launched the Age-Friendly Hospital Measure. This specifies that hospitals must attest to having protocols and initiatives in place to address each of the 4Ms and have leadership to oversee continuous quality improvement for older adult care.^4,5 Hospitals must ensure that evidence-based guidelines are used to identify and address potentially inappropriate medication use, and align medication use to what matters for the patient for mentation and mobility goals. The measure does not mandate a specific approach to how this should occur. Unlike the long-term care setting, the medication review aligned with this measure should not be limited to an explicit list but should be inclusive of anything which may affect patient goals.

There are mixed data on the effectiveness of the 4M model in the health system prior to the CMS measure implementation. A 2023 study involving 3 systems that implemented the age-friendly model revealed that health care professionals found the model compelling, but difficult to implement. Interprofessional engagement and involvement along with communication, hands-on education, and dedicated resources and support were deemed necessary for success.³ The study also found that disengaged physicians and difficulty implementing the “what Matters” component to be the biggest challenges.³

However, a 2025 retrospective study found that hospitalized older adults who received the 4Ms care model with all components implemented had 15.5% lower cost (95% CI 13.02-17.92), 5.2% shorter stays (95% CI 2.91-7.37), and 10.4% lower rate of readmission (HR 0.90, 95% CI 0.84-0.95).⁶ These outcomes were even greater in a sub-analysis of the sickest patients within the cohort. These data suggest that, although implementation may be challenging, there are statistically clinical benefits and a positive effect on outcomes when utilizing the age-friendly care model for older adults.

International Applications

The age-friendly model is not unique to the United States and is being implemented in many other countries. Age-Friendly Ireland is a government-led service that promotes preparing the infrastructure and services for the rapid increase in the older adult population.⁷ They have an annual awards showcase to recognize the innovative ideas and initiatives from around the country that contribute to their core values.⁷ The program allows businesses, including pharmacies, to become certified as an accredited age-friendly business.

The International Pharmaceutical Federation highlighted a community pharmacy in Manchester, England for their age-friendly approach. The pharmacy provides a traditional medication use review service for patients, allowing them an opportunity to discuss medications and other needs with the pharmacist, similar to pharmacy practice in the United States.⁸ The pharmacy also offers several specific items to enhance medication use in older adults, including compliance aids, large print labels, colored tags to identify patients who need extra support, and adaptive tools for those with visual impairment, hearing decline, and dexterity difficulties.⁸ They also have accessibility accommodations throughout the pharmacy, including ramps, handrails, and wider aisles throughout the store. The pharmacy intentionally evaluates their patients’ social needs, such as the ability to obtain fuel in winter or purchase groceries and connects patients with the appropriate community and social service resources.

Although the delivery of pharmaceutical care is consistent with pharmacy practice across the world, these pharmacies have recognized a key principle for community pharmacies: that adjusting the physical aspect of the pharmacy can be just as important as the medication-related services provided. The pharmacy should be well-lit, free from hazards, and easy to navigate with at least some wide aisles. The pharmacy counter should be accessible for those with disabilities or mobility issues and provide a separate counseling area or room free from noise that not only allows for privacy but reduces the impact of background noise during counseling. Blister or pill packs can be offered to those who have difficulty opening medication bottles or keeping track of dosing.

For those who are visually impaired, prescription bottles that speak or provide verbal instructions may be useful. This innovation, which was originally designed for blind patients, utilizes RFID text-to-speech technology, allowing patients to hear prescription information read aloud by scanning the electronic label with a mobile app. ^9-10 For patients without access to a device with which to use an app, some companies providing this technology also offer a station approximately the size of an portable compact disc player, which can be used at home and provides the same information as the app. Other adaptable technology that may benefit some older adults includes talking prescription recorders that can be attached to the prescription bottle, container closures that can be opened with 1 hand (and differ from traditional non-child resistant tops), and sensors that can help with medication schedules and adherence.^11-13

Age-friendly care is also essential, though not a new concept, in long-term care (LTC) pharmacy, where most patients are older adults. CMS has required long-term care facilities to screen for, minimize, and appropriately monitor medications for patients over 65 years of age for decades. Although some parts of the framework are like the inpatient setting, (eg, medication monitoring) or community setting (eg, using adaptive medication tools), there are also distinctive ways in which the pharmacist can implement the model in the LTC environment.

Transitions of care are often a point where many medication errors occur. Pharmacists can ensure that the medication reconciliation is done and uploaded in the electronic health record (EHR), send messages to necessary providers when changes are made, and include the patient and/or caregiver to minimize errors and discrepancies.¹⁴ Older adults often require different educational methods for medications. To increase adherence, pharmacists can create prescription handouts that provide medication specifics and provide counseling over several visits or with a follow-up phone call after transitioning.¹⁴ Although these methods may be applicable to other areas, they are especially important in long-term and transitions of care.

Conclusion

Older adults are the largest consumer of medications and often experience higher rates of adverse events and worse outcomes as a result. The Age-Friendly 4M’s framework offers an evidence-based approach to providing care that is specific to the needs of older adults in multiple areas of pharmacy. This framework allows patients to implement what matters to them while also promoting safe and effective medication use, cognitive well-being, and mobility. Pharmacists can offer unique and practical approaches to different components in specific settings, while still covering the component of safe and effective medication use in every area. Evidence also supports favorable outcomes for the age-friendly model, even with the challenges of implementation. While some areas of pharmacy have begun to implement this model, there is an opportunity for most areas of pharmacy to adopt some if not all the components.

REFERENCES

1. Howe RJ, Rieke K, Bayer T, et al. Strategies and Outcomes of Age-Friendly Health System Implementation in Outpatient Settings: A Systematic Review. INQUIRY: The Journal of Health Care Organization, Provision, and Financing. 2025;62. doi:10.1177/00469580251318244

2. Age-Friendly Care. The John A. Hartford Foundation. Accessed 14 Oct. 2025. www.johnahartford.org/grants-strategy/current-strategies/age-friendly/age-friendly-care#4ms

3. Adler-Milstein JR, Krueger GN, Rosenthal SW, Rogers SE, Lyles CR. Health system approaches and experiences implementing the 4Ms: Insights from 3 early adopter health systems. J Am Geriatr Soc. 2023;71(8):2627-2639. doi:10.1111/jgs.18417

4. Pelton LJ, Mate K, Snyder RE, Fulmer T. A Path to Better Care for Older Adults: Optimizing Medicare and Medicaid Payments Through Implementation of the CMS Age Friendly Hospital Measure. Inquiry. 2025;62:469580251342460. doi:10.1177/00469580251342460

5. CMS Approves New 2025 Age-Friendly Hospital Measure. The John A. Hartford Foundation. Accessed 14 Oct. 2025. www.johnahartford.org/resources/view/cms-passes-new-2025-age-friendly-hospital-measure 

6. Drago K, De Lima B. Association of Age-Friendly Hospital Care and Patient Outcomes for Older Adults. Jt Comm J Qual Patient Saf. July 25, 2025. doi:10.1016/j.jcjq.2025.07.008

7. Age Friendly Ireland. May 14, 2024. https://agefriendlyireland.ie/

8. How Pharmacies Are Helping to Create Age-Friendly Communities. Fip,14 May 2019, www.fip.org/how-pharmacies-are-helping-to-create-age-friendly-communities

9. Talking Prescription Labels: ScripTalk. ScriptAbility. Accessed 3 Nov. 2025. www.scriptability.com/scriptalk-talking-labels 

10. Baig EC. Talking labels aid the blind with prescriptions. AARP. December 22, 2021. Accessed November 4, 2025. https://www.aarp.org/personal-technology/talking-prescription-drug-labels/ 

11. Tel-Rx Talking Prescription Recorder. Accessed November 4, 2025. https://www.maxiaids.com/product/tel-rx-talking-prescription-recorder?gad_source=1&gad_campaignid=700200430&gclid=Cj0KCQiA5abIBhCaARIsAM3-zFU-oQVvZtulIyM7V3jMLHyE8b7DftrqTW0TRpzn7I2r-cyoAcDXTq8aAlmXEALw_wcB

12. SnapSlide. Accessed 4 November 2025. https://www.snapslide.com/how-it-works

13. Schwartz A. A cell phone in a pill bottle, to text you to remember your meds. Ageing Mind Initiative. 2013. Accessed November 4, 2025. https://ami.group.uq.edu.au/cell-phone-pill-bottle-text-you-remember-your-meds

14. Medication Management Technologies for Long-Term and Post-Acute Care: A Primer and Provider Selection Guide. LeadingAge. September 27, 2022. leadingage.org/medication-management-technologies-long-term-and-post-acute-care-primer-and-provider/#4.5