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      Evidence for the 4Ms: Interactions and Outcomes across the Care Continuum

      research-article
      , MD 1 , , PhD, RN, FAAN 2 , , MPA 1 , , RN 2 , , PhD, RN 1 , , BS 3 , , BS 3
      Journal of Aging and Health
      SAGE Publications
      goal-directed care, quality, safety

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          Abstract

          Objectives: An expert panel reviewed and summarized the literature related to the evidence for the 4Ms—what matters, medication, mentation, and mobility—in supporting care for older adults. Methods: In 2017, geriatric experts and health system executives collaborated with the Institute for Healthcare Improvement (IHI) to develop the 4Ms framework. Through a strategic search of the IHI database and recent literature, evidence was compiled in support of the framework’s positive clinical outcomes. Results: Asking what matters from the outset of care planning improved both psychological and physiological health statuses. Using screening protocols such as the Beers’ criteria inhibited overprescribing. Mentation strategies aided in prevention and treatment. Fall risk and physical function assessment with early goals and safe environments allowed for safe mobility. Discussion: Through a framework that reduces cognitive load of providers and improves the reliability of evidence-based care for older adults, all clinicians and healthcare workers can engage in age-friendly care.

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          Most cited references102

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          Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test.

          This study examined the sensitivity and specificity of the Timed Up & Go Test (TUG) under single-task versus dual-task conditions for identifying elderly individuals who are prone to falling. Fifteen older adults with no history of falls (mean age=78 years, SD=6, range=65-85) and 15 older adults with a history of 2 or more falls in the previous 6 months (mean age=86.2 years, SD=6, range=76-95) participated. Time taken to complete the TUG under 3 conditions (TUG, TUG with a subtraction task [TUGcognitive], and TUG while carrying a full cup of water [TUGmanual]) was measured. A multivariate analysis of variance and discriminant function and logistic regression analyses were performed. The TUG was found to be a sensitive (sensitivity=87%) and specific (specificity=87%) measure for identifying elderly individuals who are prone to falls. For both groups of older adults, simultaneous performance of an additional task increased the time taken to complete the TUG, with the greatest effect in the older adults with a history of falls. The TUG scores with or without an additional task (cognitive or manual) were equivalent with respect to identifying fallers and nonfallers. The results suggest that the TUG is a sensitive and specific measure for identifying community-dwelling adults who are at risk for falls. The ability to predict falls is not enhanced by adding a secondary task when performing the TUG.
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            Practice guideline update summary: Mild cognitive impairment

            To update the 2001 American Academy of Neurology (AAN) guideline on mild cognitive impairment (MCI).
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              Lifestyle interventions to prevent cognitive impairment, dementia and Alzheimer disease

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                Author and article information

                Journal
                J Aging Health
                J Aging Health
                spjah
                JAH
                Journal of Aging and Health
                SAGE Publications (Sage CA: Los Angeles, CA )
                0898-2643
                1552-6887
                8 February 2021
                August 2021
                : 33
                : 7-8
                : 469-481
                Affiliations
                [1 ]Ringgold 44023, universityInstitute for Healthcare Improvement; , Cambridge, MA, USA
                [2 ]Ringgold 44194, universityThe John A. Hartford Foundation; , New York, NY, USA
                [3 ]universityColumbia University Mailman School of Public Health; , New York, NY, USA
                Author notes
                [*]Terry Fulmer, John A. Hartford Foundation, 55 East 59th Street, 16th Floor, New York, NY 10022, USA. Email: terry.fulmer@ 123456johnahartford.org
                Author information
                https://orcid.org/0000-0001-6841-4902
                Article
                10.1177_0898264321991658
                10.1177/0898264321991658
                8236661
                33555233
                1083776d-218d-43e9-866b-950a66359270
                © The Author(s) 2021

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

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                Custom metadata
                August-September 2021
                ts10

                goal-directed care,quality,safety
                goal-directed care, quality, safety

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