Age-Friendly Health System Recognition and Its Association with Improved Clinical Outcome Measures

The number of adults 65 years of age and older is rapidly increasing, as is health care utilization by older adults with multiple chronic conditions. The Age-Friendly Health Systems (AFHS) movement, with a focus on What Matters, Medication, Mentation, and Mobility (the 4Ms), was launched in 2017 to improve management of older adults across health care settings. However, evidence of impact on outcomes remains limited. Using a national cohort of 4002 hospitals (388 with AFHS recognition from the Institute for Healthcare Improvement, as of December 31, 2024, and 3614 controls), the authors explore the associations between AFHS recognition and hospital readmission rates, mortality, and patient-reported experiences. Using difference-in-differences analyses, the authors find that level 2 AFHS recognition (i.e., hospitals with at least 3 months of data of older patients who have received 4Ms care) is associated with lower 30-day mortality rates for acute myocardial infarction (-0.41 percentage points; 95% confidence interval [CI], -0.75 to -0.06), pneumonia (-0.71; 95% CI, -1.29 to -0.13), and stroke (-0.56; 95% CI, -1.06 to -0.07). Level 1 recognition (i.e., hospitals that have successfully developed plans to implement the 4Ms) is associated with lower readmission rates only for pneumonia (-0.40; 95% CI, -0.69 to -0.10). Furthermore, both level 1 and level 2 recognition are associated with modest reductions in Medicare spending per beneficiary. No determinative associations were identified between AFHS recognition and patient-reported experience measures. These findings provide one of the first national studies to suggest that organizations with AFHS recognition could be associated with improvement in certain outcomes and spending.