Association of Age-Friendly Hospital Care and Patient Outcomes for Older Adults

Hospitalized older adults are at greater risk for hospital-acquired complications than their younger counterparts. The Age-Friendly Health Systems 4Ms care delivery framework-What Matters, Mentation, Mobility, and Medication-provides evidence-based practices to improve care for older adults. This study assessed if 4Ms care in the hospital was associated with better patient outcomes and lower costs.

The authors retrospectively analyzed adults aged 65 years and older hospitalized at an academic hospital from September 2020 through December 2023 based on age-friendly status. Primary outcomes were length of stay (LOS), total charges, and 30-day hospital and emergency department (ED) readmissions. Linear regression models were used for LOS and total charges. Survival analyses and Cox proportional hazards models analyzed the 30-day hospital and ED readmissions. All models used propensity score matching to minimize confounding. Subgroup analyses were based on high and low case mix index (CMI).

The sample included 20,202 admissions for patients aged 65 years and older. The hospitalized older adults receiving 4Ms care had 15.5% lower hospital charges (95% confidence interval [CI] 13.02-17.92), 5.2% shorter stays (95% CI 2.91-7.37), and had a 10.4% lower rate of hospital and ED readmissions (hazard ratio 0.90, 95% CI 0.84-0.95) than those not receiving 4Ms care. The 4Ms recipients with a higher CMI had lower charges, shorter lengths of stay, and a lower risk of readmission than recipients with a lower CMI.

The 4Ms care delivery framework was associated with reduced inpatient utilization and overall cost of care. These results support reliable delivery of the 4Ms to benefit older hospitalized adults.