Age-Friendly Health Systems in Hospital at Home: An Integrated Healthcare System Cross-Sectional Survey

Background Age-Friendly Health Systems (AFHS) is an evidenced-based initiative structured on the 4Ms framework (What Matters, Medications, Mentation, and Mobility) to improve care for older adult patients and has been implemented across the United States in various care settings. The Veterans Affairs (VA) Hospital-at-Home (HaH) program provides hospital-level care in patients’ homes in order to improve outcomes for older adults and to provide care in a setting that patients feel most comfortable – home. The implementation of Age-Friendly care into VA HaH has not been previously described. Objective Assess the implementation of the Age-Friendly 4Ms practice in VA HaH programs. Methods A survey assessing beliefs, current practices, and barriers to implementing AFHS was sent to all VA HaH Medical Directors. Descriptive statistics were used to summarize survey responses. Results 9 out of 12 Medical Directors responded to the survey (75% response rate). Seventy-seven percent of respondents were familiar with the Age-Friendly 4Ms and reported that it is ‘very’ or ‘extremely’ important to follow the 4Ms framework in HaH. Over 75% of Medical Directors reported evaluating patient goals, performing medication assessments, and screening for mobility limitations. Notable gaps include addressing the Mentation ‘M.’. Only 11% of programs reported routine screening for delirium and only 44% screen for cognitive impairment and depression. Discussion AFHS care is valued by HaH Medical Directors and age-friendly care processes have been incorporated in the majority of VA HaH programs. There were significant gaps in assessing the multiple dimensions of the Mentation ‘M’. Improving performance in this area should be a focus for VA HaH and may include development of guidelines for screening of delirium, cognitive impairment, and depression among HaH patients.