Age-Friendly Health Systems(AFHS) 4Ms Framework as a tool for embedding meaningful, person-centred care across Integrated Care pathways:Perspectives from healthcare staff

Background: Older adults often experience fragmented healthcare that overlooks their individual priorities. This is particularly evident during transitions across integrated care pathways between acute and community healthcare settings. The Age-Friendly Health Systems (AFHS) 4Ms Framework (Mobility, Mentation, Medication, and What Matters Most) offers a person-centred, evidence-based approach to consistently deliver safe, high-quality, integrated care aligned with older adults’ values. This study aimed to explore healthcare professionals’ lived experience on implementing the AFHS 4Ms Framework within Irish integrated healthcare settings.

 

Approach: A qualitative, interpretive, phenomenological design was used to evaluate the implementation of the AFHS 4Ms Framework across three healthcare services (a residential care facility, a rehabilitation ward and an emergency department). Ten semi-structured interviews were conducted with purposively sampled multidisciplinary team members to capture diverse perspectives. Using the Normalisation Process Theory framework, interviews explored how staff understood, engaged with, and integrated the 4Ms into daily practice. Transcribed interviews were analysed thematically using open coding.

 

Results: The overarching theme identified the 4Ms Framework as ‘a supportive and enabling structure’ to deliver quality, person-centred care to older persons in acute and community healthcare settings. This was underpinned by three major themes 1) Ability of the 4Ms Framework to align with existing practices across different care settings and adapt to an Irish context; 2) Securing sustainability of an AFHS with stakeholder involvement, managing workload perceptions, scalable implementation and motivating teams, 3) Impact of the 4Ms Framework as a driver of the implementation process by meaningfully enhancing quality person-centred care delivery through facilitating MDT communication and empowering staff and patients.

 

Successful implementation of the AFHS 4Ms Framework was shaped by key facilitators and barriers identified by healthcare staff. Facilitators included a supportive, adaptable structure; early stakeholder engagement; the presence of an implementation champion; and a scalable plan that enhanced multidisciplinary team engagement and person-centred care. Importantly, implementation required minimal additional resources, supporting feasibility across Integrated Care settings.

 

However, barriers emerged that could undermine sustainability and impact. These included reliance on americanised resources that lacked local relevance, the risk of tokenistic adoption post-accreditation, limitations in workflow integration and applicability across diverse settings, and the absence of formal outcome evaluation processes. Addressing these barriers while leveraging the identified facilitators is essential for embedding the 4Ms Framework meaningfully into Integrated Care pathways and ensuring its long-term contribution to quality improvement and person-centred service delivery.

 

Implications: This study demonstrates that the AFHS 4Ms Framework can be a powerful enabler of Integrated Care that places older adults at the centre of decision-making. By aligning care with personal goals the Framework meaningfully enhances the planning and delivery of care of the individual. Key recommendations from the findings include establishing regional steering groups, developing tailored implementation toolkits, integrating the 4Ms into electronic health records, and building communities of practice. Ultimately, the 4Ms Framework supports a shift toward proactive, coordinated care that engages and empowers older people as partners in their health and wellbeing, and empowers multidisciplinary teams to co-create that care across an integrated healthcare pathway.