Background: The U.S. population is aging rapidly, with adults ≥65 expected to rise from 18% today to 23% by 2054 (1). Hospital medicine must evolve to meet the increasingly complex needs of this population. The Institute for Healthcare Improvement and the John A. Hartford Foundation have pioneered age friendly care movement through the evidence-based 4M framework—What Matters, Medication, Mentation, and Mobility—which has been shown to reduce readmissions, shorten length of stay, prevent functional decline, and enhance patient experience. At our community hospital, where >63% of patients are seniors we integrated the 4Ms into daily interdisciplinary rounds (IDRs). We believe this structured, age-friendly approach contributed towards us achieving CMS 5-Star rating for two consecutive years.
Purpose: To integrate the 4M framework into the culture and daily workflow of hospital medicine through IDRs, with the goal of delivering reliable, high-value, patient-centered care for older adults.
Description: In 2020, we redesigned IDRs to consistently incorporate the 4Ms for all patients, with particular focus on adults ≥65. Each morning, the team reviews patient status through a geriatric lens. Mentation is screened daily using the BCAM tool, allowing early identification of delirium and rapid initiation of non-pharmacologic interventions, reducing reliance on sedating medications and decreasing caregiver stress. Mobility goals and functional needs are discussed to prevent deconditioning and support timely discharge home. The presence of physical therapists during IDRs enables immediate evaluation and intervention for patients at risk of functional decline. Medication safety is addressed in real time as the clinical pharmacist reviews high-risk medications, recommends deprescribing when appropriate particularly high-risk medications such as opioids and benzodiazepines. Nursing contributes each patient’s daily “What Matters” goal to align care plans with individual preferences. Hospitalists incorporate this information into bedside discussions, reinforcing shared, patient-centered decision-making.We reviewed hospital-level Tableau data from 2020–2025 which showed sustained improvement following 4M implementation. Excess days per case improved from 0.06 (2020) to –0.26 (2025 YTD), reflecting more efficient, goal-aligned care. All-cause 30-day readmissions decreased from ~14% (2021) to ~12% (2025 YTD) with more reliable mentation and mobility practices. Patient experience improved in parallel, with HCAHPS Care Transition percentile rankings increasing by more than 10 points, driven by clearer communication, medication-safety discussions, and consistent “What Matters” conversations. We believe these gains have contributed to our CMS 5-Star ratings in 2024 and 2025. While multifactorial, improvements in LOS, readmissions, and patient experience aligned closely with standardized 4M application during IDRs.
Conclusions: With a rapidly growing older adult population and increasing CMS emphasis on age-friendly standards, hospital medicine must lead the transformation toward evidence-based geriatric care. Embedding the 4Ms into daily interdisciplinary workflows is practical, scalable, and effective. Our experience shows that a consistent age-friendly approach can improve outcomes for older adults while strengthening overall hospital quality and performance.