From the 4Ms to a Disability-Friendly Healthcare System

There are approximately 3,922 Age-Friendly Health Systems (AFHS) sites in the United States. These systems promote better healthcare for adults aged 65 and older by implementing the following 4 elements, referred to as the "4Ms," into care provision: (1) what matters; (2) medication; (3) mentation; and (4) mobility. There are no equivalent parameters to ensure high-quality care for adults with disabilities. This is problematic because many individuals with disabilities experience conditions associated with aging well before their 65th birthday. For example, adults with Down syndrome are more likely to develop earlier-onset dementia and many will be diagnosed with Alzheimer's disease in their early 50s. While AFHS are of critical importance, by focusing solely on adults over age 65, we are missing an opportunity to improve the health and well-being of people with disabilities. Many adults living with disabilities would likely benefit from providers deliberately and thoughtfully addressing what matters, medication, mentation, and mobility. In this paper, we posit that implementing the 4Ms framework with younger adults with disabilities has the potential to both enhance compliance with the Americans with Disabilities Act and lay the groundwork for making an equitable, disability-friendly health system a reality.