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As individuals age, their body's physiology evolves, affecting drug pharmacokinetics. The most apparent changes occur in the gastrointestinal tract, where an increase in gastric pH, a delay in gastric emptying, and a reduction in gastrointestinal motility are observed. Remarkably, these changes do not substantially modify the absorption of orally administered drugs, particularly those absorbed via passive diffusion.Transdermal drug delivery emerges as a highly viable method for older adults due...
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In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
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Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
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Drug distribution in the human body is influenced by several factors, including plasma protein concentration, body composition, blood flow, tissue-protein concentration, and tissue fluid pH. Among these, changes in plasma protein concentration and body composition due to aging significantly affect how drugs are distributed within the body. Specifically, aging is associated with a decrease in albumin levels by about 10% and an increase in α1-acid glycoprotein levels. These alterations are...
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Age-Friendly Health System Implementation in Outpatient Settings: A Systematic Review.

Rebecca J Howe1,2, Katherine Rieke1,3, Htun Ja Mai4

  • 1VA Providence Healthcare System, THRIVE COIN, Providence, Rhode Island, USA.

Journal of the American Geriatrics Society
|February 16, 2026
PubMed
Summary
This summary is machine-generated.

Implementing Age-Friendly Health Systems (AFHS) in outpatient settings shows improved processes across the 4Ms framework. However, more research is needed on specific strategies and patient-centered outcomes for older adults.

Keywords:
4Msage friendlyage friendly health systemoutpatientwhat matters; mentation; medication; mobility

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Area of Science:

  • Gerontology
  • Health Services Research
  • Implementation Science

Background:

  • The Age-Friendly Health Systems (AFHS) initiative utilizes the 4Ms framework (What Matters, Medication, Mentation, Mobility) to enhance care for older adults.
  • While evidence exists for individual components, limited data guides the outpatient implementation of all 4Ms collectively.

Purpose of the Study:

  • To systematically review the evidence on the impact of implementing AFHS in outpatient settings.
  • To identify effective strategies for integrating the 4Ms framework into routine clinical practice for older populations.

Main Methods:

  • A comprehensive search of major databases (Medline, EMBASE, CINAHL, Cochrane) and clinicaltrials.gov was conducted from 2015 to November 2024.
  • Included were comparative studies implementing all 4Ms in outpatient settings, with risk of bias assessed and results summarized using GRADE methodology.

Main Results:

  • Twelve US-based studies indicated that AFHS interventions improved process measures across all 4Ms.
  • The effectiveness of specific implementation strategies was indeterminate, and outcome/structural measures were rarely reported.
  • Study heterogeneity and poor reporting restricted the generalizability of findings.

Conclusions:

  • There is a critical need for standardized, outcomes-focused AFHS measurement in outpatient settings prior to policy expansion.
  • Future research should prioritize implementation fidelity, robust outcome evaluation, and measures reflecting older adults' values and experiences.