Irish Healthcare Staff Perspectives on the Implementation of the Age-Friendly Health Systems 4Ms Framework. A...

The Age-Friendly Health Systems (AFHS) 4Ms Framework (what Matters most, Medication, Mentation, and Mobility) is an internationally recognized, evidence-based approach to deliver consistent, person-centered care to older adults in all healthcare settings. This qualitative study evaluated the implementation of the 4Ms Framework, from the perspective of multidisciplinary team members, at three early-adopter healthcare services in Ireland.

Ten one-to-one semi-structured interviews were conducted with doctors, nurses, and health and social care professionals working in three distinct healthcare settings in Ireland.

A qualitative interpretive phenomenological design was adopted, following the Standards for Reporting Qualitative Research guidelines. Participants were purposively sampled to capture diverse perspectives across services, disciplines, and roles. The topic guide was informed by the Normalization Process Theory. Interviews were audio-recorded, transcribed verbatim, anonymized, and analyzed manually using iterative thematic content analysis.

The overarching theme identified, a supporting and enabling structure, was supported by three major themes: (1) Ability of the 4Ms Framework to facilitate an AFHS approach, (2) Securing sustainability of an AFHS, and (3) Impact of the 4Ms Framework as a driver of the implementation process. Based on these findings facilitators to implementation included early stakeholder engagement, strong leadership, and a scalable approach that fostered multidisciplinary collaboration and person-centered care with minimal extra resources. Barriers to implementation included reliance on Americanized materials, risks of tokenistic adoption, variable integration across settings, and limited outcome evaluation.

The AFHS 4Ms Framework supports transformative, person-centered care across diverse settings. This first Irish AFHS evaluation provides recommendations for wider implementation of the 4Ms Framework while contributing novel insights to the international implementation evidence base. This study emphasizes the need to adapt the 4Ms Framework to local systems, integrate robust evaluation, and build on the identified facilitators while addressing barriers to achieve sustainable, scalable adoption within healthcare settings.