The Age-Friendly Health Systems Initiative: Innovations in the Acute Care Setting

The Age-Friendly Health Systems (AFHS) is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI). In March 2020, the Veterans Health Administration (VHA) Office of Geriatrics and Extended Care set a goal to become the most extensive integrated healthcare system in the U.S. to be recognized by IHI as Age-Friendly. As of July 10, 2023, 113 VHA Medical Centers have earned IHI recognition across all 18 VISNs in 246 care settings. AFHS uses an essential set of evidence-based practices known as the '4Ms' (Mobility, Mentation, Medication, and What Matters) to improve care for older adults.

The number of older Veterans is increasing rapidly. In Fiscal Year (FY) 2019, 48% of VHA enrollees were ages ≥ 65. Between FY2019-2039, Veterans age ≥ 85 are projected to increase by 38%. At the VA Boston Healthcare System, we identified the acute care setting as an opportunity for improving Age-Friendly care. Due to the rapidly growing number of patients with major neurocognitive disorders and ongoing challenges in finding appropriate placement for them in the community, many of these patients remain in the hospital for extended periods.

Physicians, nurses, and support staff, encounter many opportunities to improve the care of patients with behavioral and psychological disturbances associated with neurocognitive disorders and delirium. Unfortunately, behavioral codes are frequently called for wandering patients and for those who struggle with agitation due to acute or chronic confusion. For Veterans with cognitive deficits, and some with post-traumatic stress disorder, a sudden gathering of many people during these codes can result in increased distress, confusion, and agitation. Moreover, medications administered to treat these disturbances entail significant risks, such as confusion, sedation, infection, falls, and death.

To best support patients and staff, a multidisciplinary team at VA Boston came together to develop Age-Friendly 4Ms initiatives in the acute care setting to improve the safety and well-being of patients and staff. These interventions provide non-pharmacologic interventions, minimizing behavioral codes and medication administration, and shortening length of stay.

In this session, we will present multiple initiatives and innovations implemented in a VA Boston acute setting and their impact on care.

Our geropsychologists will describe the adaptation and implementation of a tailored behavioral intervention. Our clinical resource nurses will share data on dementia education developed to provide nursing and support staff with the knowledge and tools they need to provide Age-Friendly care and improve the well-being of older adults with neurocognitive disorders. This presentation will emphasize adaptations made to support acute care staff. They will also discuss an innovative resource, the “Age-Friendly toolkit”, a versatile collection of items, focusing on the 4Ms, and intended to provide relief and comfort to older patients with delirium and dementia. Our physical therapist assistant will share the implementation of a program which improves mobility and engagement of older adults by accompanying them for twice daily walks in the hospital.

Finally, our geriatric psychiatrist will provide data supporting the benefits of these tools, and share future plans of developing a Behavioral Reach Out (BRO) team in the acute hospital setting. BRO is designed to proactively develop behavioral plans, assist with placement in the community, and provide robust support to staff in community long-term care facilities to mitigate rehospitalization or placement “failures”.