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Updated: Jan 11, 2026

Oral Health Assessment by Lay Personnel for Older Adults
Published on: February 2, 2020
Supporting Older Adults at Risk (SOAR): A Nurse-Led Model to Achieve Age-Friendly Care
Purpose:
To describe a model of nurse-led age-friendly care in the acute care setting and associated processes and outcomes aligned with the 4Ms Framework.
Method:
We implemented the Supporting Older Adults at Risk Model-a novel model of care that includes primary care geriatric nurse practitioner co-management and AGS CoCare®:HELP-and used descriptive statistics to evaluate outcomes aligned with each of the 4Ms: What Matters, Medication, Mentation, and Mobility.
Results:
Advance care planning conversations were documented for 81% of the selected sample, resulting in subsequent family meetings and goal-concordant care. Beers Criteria® and anticholinergic medications were identified and reduced. Mobility goals were identified for 100% of the selected sample and mobility was maintained or improved for 46%. Addressing mentation was done in alignment with What Matters.
Conclusion:
Nurses are well-positioned to lead age-friendly care and drive optimal outcomes in the acute care setting, especially considering the geriatrician work-force shortage.
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