What Is the Age-Friendly Health System Initiative (AFHS)?

The Age-Friendly Health Systems (AFHS) initiative is a nationwide movement to transform healthcare so that it better meets the needs of older adults. Launched in 2017 by The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI)—in partnership with the American Hospital Association (AHA) and the Catholic Health Association of the United States (CHA)—the initiative’s goal is to ensure that every older adult receives safe, evidence-based, and person-centered care across all healthcare settings.

The 4Ms Framework

At the core of the AFHS initiative is the 4Ms framework, which identifies the four essential elements of high-quality care for older adults:

1. What Matters: Know and align care with each older adult’s specific health goals and preferences, including end-of-life care.
2. Medication: Use age-friendly medications that do not interfere with What Matters, Mentation, or Mobility.
3. Mentation: Prevent, identify, treat, and manage dementia, depression, and delirium across care settings.
4. Mobility: Ensure that older adults move safely every day to maintain function and do What Matters.

Implementing the 4Ms together creates a holistic, integrated approach to care that can improve health outcomes and quality of life for older adults.

Recognition Levels

Healthcare organizations can achieve formal recognition as Age-Friendly Health Systems by reliably implementing the 4Ms framework. There are two recognition levels:

• Participant: Organizations that have developed an action plan to implement the 4Ms.
• Committed to Care Excellence: Organizations that have demonstrated consistent implementation of the 4Ms over time.

As of recent reports, more than 5,300 sites have been recognized as Age-Friendly Health Systems.

How to Get Started

The initiative provides a range of resources to help organizations implement the 4Ms, including):

• Action Communities — Collaborative learning opportunities where healthcare teams can learn, test, and adopt the 4Ms.
• Online Courses with Coaching — Structured educational programs that teach the 4Ms and help teams put them into practice.
• Getting Started Guides — Practical resources to support organizations at every stage of their age-friendly journey.

By embedding these principles into everyday practice, healthcare providers can help ensure that older adults receive care that is safe, effective, and aligned with their values.