# How to Put the 4Ms Into Practice: Age-Friendly Care in the ED About This Podcast What if the most important thing we can do for an older adult in the emergency department (ED) isn’t just to treat what brought them in - but to protect what matters most to them? Introducing the 4Ms framework: What Matters, Medication, Mentation, and Mobility, a foundation for delivering age-friendly care. In today’s episode, Dr. David Zodda joins GEMCast host Dr. Christina Shenvi to share his expertise on the 4Ms and the importance of addressing them in emergency care. David Zodda is an award-winning board-certified emergency medicine physician, fellowship-trained in evidence-based medicine, and recipient of the National Medicine Award for Clinical Excellence. He is also the founder of BetterMedicine.com, an online social media platform turning research into practical strategies for better health. He practices at Northern Light Mercy Hospital in Portland, Maine. Zodda shares personal stories, highlights emerging evidence, and offers practical approaches to integrate the 4Ms into your practice. Tune in to learn how using the evidence-based framework can help patients maintain independence, reduce avoidable hospitalizations and readmissions, and deliver care that treats the patient, not just the diagnosis. Play the Episode https://soundcloud.com/gemcast/how-to-put-the-4ms-into/s-XL4j77gedCg?si=75da501ddc6640ffbf8390464416524e&utm_source=clipboard&utm_medium=text&utm_campaign=social_sharing Subscribe on YouTube Subscribe on iTunes Key Points You may already be delivering care that aligns with elements of the 4Ms framework. Rather than starting from scratch, consider how to build on your current practice. Zodda’s biggest piece of advice: sit down with the patient. To elicit “What Matters”, start with questions such as “Why does this matter to you?” and “Can we talk about your health for a moment?”  Also, consider using motivational interviewing. Dementia, depression, and delirium should not be dismissed as a normal part of aging. Screen your patients for cognitive impairment and ensure that simple interventions to help prevent delirium in the ED are in place. When possible, consider if there are any easy, quick interventions that can be done at the bedside. For example, hearing loss is a modifiable risk factor for dementia. To address this, consider booking an audiologist appointment with the patient. Mobility is about more than just preventing falls; it’s also about maintaining independence and function. Depending on the resources in your ED, you may be able to involve other members of the team such as PT, OT and registered dietitians. If a patient is up and moving, it’s an opportunity to assess their strength, balance and coordination. Deprescribing medications can be a daunting task, especially when you are not the one who did the initial prescribing. Review whether a medication is necessary, and if it is, ask, “Is there a safer alternative?” For example, changing an oral NSAID to topical diclofenac for knee osteoarthritis. Use resources such as AGS Beers Criteria® to support medication prescribing and deprescribing. Check out guest Dr. David Zoddas' free online platform that offers podcasts, coaching and a weekly newsletter. Visit BetterMedicine.com Read the Evidence Learn more about the research mentioned in this episode. The Lancet | August 10, 2024 Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission This report synthesizes the latest high-quality evidence on dementia prevention, treatment and care. It identifies 14 modifiable risk factors for dementia. As mentioned in this episode, 45% of dementia cases could be prevented or delayed through addressing modifiable risk factors. Since the previous edition, published in 2020, two new modifiable risk factors (untreated vision loss and high LDL cholesterol) have been added. Read More Journal of Bone and Mineral Research | February 1, 2018 High‐Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial This randomized controlled trial from Australia found that in postmenopausal women with osteoporosis, high-intensity resistance and impact training is beneficial for bone mineral density and functional performance. Read More Annals of Emergency Medicine | August 25, 2020 Can an Emergency Department–Initiated Intervention Prevent Subsequent Falls and Health Care Use in Older Adults? A Randomized Controlled Trial A randomized controlled trial showing that a fall-prevention intervention involving pharmacists and PT. Patients receiving the intervention had similar ED lengths of stay and less fall-related ED visits at 6 months. Read More US Deprescribing Research Network A network for evidence about deprescribing and the optimization of medications used by older adults. Visit Website Next, listen to the previous GEMCast episode, Bringing the Heart Back to Medicine by Addressing Social Drivers of Health with Kristie Foster. Play Episode CMS Measure Support Guide for EDs Aligning National & Strategic Priorities Better care for older adults starts with concrete, evidence-based processes in the ED. Learn to drive change by aligning the CMS Measure with Age-Friendly Health Systems and GEDA Accreditation. Our new resource hub shows you how. Explore Resource Hub