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

Abstract

Background: 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.

Methods: 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).

Results: 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.

Conclusion: 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.