Life expectancy rates over the past century have nearly doubled. And as Terry Fulmer, president of The John A. Hartford Foundation, sees it, increased longevity is the greatest success story of the 20th century.  

Speaking to an audience of seniors housing and care leaders gathered for NIC Talks at the 2019 NIC Fall Conference last month, she said “Here’s your moment, your inflection point, your opportunity to think about how we celebrate this wonderful success and take a look at how we can maximize these additional years in life.”  

Fulmer believes with this extended lifespan comes a call for age-friendly health systems that adapt to the needs of the older population. Age-friendly health systems celebrate and maximize longevity, provide the best care, offer greater customer satisfaction, and at a more reasonable cost, she noted 

The World Health Organization (WHO) launched an “age friendly cities” initiative in 2006 to, among other things, bring focus to ways cities could become more accommodating to older adults and their familiesAARP then brought focus to age friendly communities, described as those that are inclusive and considerate of the perspectives of all residents, of all ages and all persuasions.  

Without age friendly health care systems in those communitiesFulmer noted, older adults may not be fully served. “You’re not an age friendly community if you can’t get someone the care they need, the way they want it, in the time that it should be delivered, said Dr. Fulmer.  

She then presented the 4Ms framework health care providers can use to inform their work with older patients.  

Developed in partnership with the Institute for Healthcare Improvement (IHI), the 4Ms framework was based on research into “the 70+ care models that we know, based on science, improved care for older adults, said Fulmer.  

The research resulted in identification of four elements of senior health they labeled the 4Ms: What Matters, Mobility, Mentation, and Medication. According to Fulmer, these four elements need to be working, and in balance, for the older adult’s health to be working, “Any one of those off kilter will set the others into a cascade of problems.”  

What Matters 

“Healthcare providers should be asking ‘What matters to you?’ instead of ‘What’s the matter with you?’, said Fulmer. This, she said, will fundamentally change the clinical encounter. It allows care providers to focus on patients as individuals, thinking about their wants and needs, for more personal care. 


Older adults typically take several medications, often prescribed by different doctors with inconsistent monitoring across the health care system. According to Fulmer, about 80% of people in a given year have some sort of adverse drug effect, and that’s a problem.” Age friendly health care requires a better way to monitor a patient’s medications, both what is prescribed and what is taken. 


Despite common misperception, depression is not a normal part of aging, noted Fulmer. When evaluating older patients’ mental acuity, care providers should consider other causes that could contribute to an apparent decline in cognition. Is the patient’s medication causing cognitive changes, for example, or perhaps he isn’t wearing his hearing aids consistently? 


“Mobility is one of the things people want most in their life, and is so essential to our sense of wellbeing,” said Fulmer. Beyond preventing falls, age friendly health systems should work to enhance mobility. 

Fulmer and her team have partnered with the American Hospital Association (AHA) and the Catholic Health Association of the United States (CHA) to implement the 4M model. Their goal is to hit 20% of health systems by 2020.  

But, said Fulmer, “do not think of this as just a hospital problem. This is all of us continuity of care across settings.” She challenged the audience to consider what they will do differently in their age friendly work tomorrow.  

To watch a replay of Dr. Fulmer’s 2019 NIC Talk, visit