A multisite evaluation of Age Friendly Health System (AFHS) 4Ms Framework implementation in Ireland

Abstract Background The AFHS 4Ms framework is an internationally recognised, evidence-based model promoting person-centred care for adults over 65. In the South West of Ireland, AFHS accreditation has been sought by multiple healthcare sites. This qualitative study explores multidisciplinary staff perspectives on implementation in acute hospital and community settings, to inform broader roll-out across the HSE South West Region. Methods Ten1-to-1 semi-structured interviews with healthcare staff across three distinct settings were conducted in March and April 2025. The interview guide was designed using the normalisation process theory framework. Interviews were audio-recorded, transcribed, and analysed using thematic content analysis with open coding. Results The overarching theme identified was that the 4Ms framework is a supportive and enabling structure that facilitates delivery of high-quality care to older adults in health settings. This theme was supported by 3 additional themes; the adaptability of the framework to facilitate an AFHS culture; resourcing to ensure sustainability of an AFHS: and the impact of the implementation as a driver of high-quality age friendly care. Success was demonstrated by improvement in quality and consistency of patient centred outcomes, staff empowerment, tailored education, integration into practice, stakeholder engagement, and clear leadership. Challenges included adapting U.S. based resources, maintaining momentum, avoiding tokenism, and varied contextual needs across settings. Conclusions This is the first Irish evaluation of AFHS implementation. Successful implementation and sustainability is achievable with appropriate resourcing and demonstrating the impact of the 4Ms framework on staff practice and patient centred care. Despite site-specific challenges, the framework proved scalable with minimal additional costs. A central knowledge-sharing hub and local champions will be essential for effective wider roll-out. Key messages • Empowering staff and embedding the 4Ms framework improves consistency in age-friendly, person-centred care across diverse healthcare settings. • Findings support scalable 4Ms roll-out across Ireland, with local champions and shared learning hubs key to sustainable implementation.