Date of Publication


Project Team

Project Advisor: Mary Val Palumbo DNP, APRN, GNP-BC Site Mentor: Nicole Haff, RN


Purpose: The Institute of Healthcare Improvement (IHI) along with the John A. Hartford Foundation partnered to promote an initiative that designates health centers as “Age Friendly Health Systems” (AFHS). These AFHS focus on providing care founded on the 4Ms (what matters, medication, mentation, and mobility).

Methods: At a rural community health center, annual wellness visits (AWVs) were reviewed retrospectively both prior to and following implementation of the 4Ms assessment. Staff received education and resources related to the 4Ms assessments and Age-Friendly Health Centers. Following the chart review, a comparative analysis for completion of each of the 4Ms assessments showed the health centers growth towards “age-friendly” care.

Results: Analysis of Annual Wellness Visits (n=101) showed an increase in the usage of new aspects of the 4Ms and consistent performance in areas already in practice. The ‘What matters?’ question improved by 35 percent, while the Mentation and Mobility assessments remained in high usage Medication follow up occurred consistently or more frequently for the eight high risk medications. Staff surveyed following implementation expressed ease of use and generalizability with using the 4Ms assessment.

Conclusions: Following implementation of the 4Ms assessment, a rural health center was able to make strides towards providing care that is “age friendly.” This was the first steps towards designation as an “Age Friendly Health System” if the site is interested in pursuing this status. The self-reported ease of use and generalizability leaves room for the 4Ms assessment to be expanded to other rural health centers within the test sites network.

Document Type


Available for download on Wednesday, May 06, 2026

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