Pharmacists as Age-Friendly 4Ms Champions in Senior Living and LTC

As the population of older adults continues to grow and their care becomes increasingly complex, long-term care (LTC) and senior living settings must evolve to meet their needs more effectively. The Age-Friendly Health Systems movement, founded by The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI), offers a practical framework to guide this transformation: the 4Ms—What Matters, Medication, Mentation, and Mobility. When implemented together, these evidence-based practices support safe, person-centered care across all settings.

Pharmacists, both in consultant and dispensing roles, are uniquely positioned to lead the charge as 4Ms champions in senior care settings. With the training, tools, and access to medication-related data, pharmacists can help operationalize the 4Ms in meaningful ways that align care with older adults’ goals and improve outcomes that matter.

Understanding the 4Ms Framework 

The 4Ms framework centers on aligning care with four key focus areas for older adults:

What Matters: Knowing and acting on each older adult’s specific health goals and care preferences.

Medication: Using only medications that do not interfere with What Matters, Mentation, or Mobility.

Mentation: Preventing, identifying, treating, and managing dementia, depression, and delirium.

Mobility: Ensuring older adults move safely every day to maintain function and do What Matters.

This framework is not just a checklist—it’s a shift in how we deliver care. By practicing the 4Ms as a set, clinicians can ensure that older adults receive care that is aligned, streamlined, and person-centered.

The Role of Pharmacists in Advancing Age-Friendly Care 

Pharmacists in senior living and post-acute and long-term care (PALTC) settings play a vital role in all four components of the 4Ms framework. As medication experts, they are natural stewards of age-friendly prescribing, deprescribing, and medication optimization. But their influence extends beyond the “Medication” M.

What Matters: Consultant pharmacists often have long-standing relationships with residents and care teams. They can initiate or contribute to What Matters conversations during medication regimen reviews and care plan meetings. When pharmacists understand a resident’s health goals, they can make informed recommendations that reflect those priorities.

Medication: Across LTC settings, pharmacists can identify high-risk medications such as anticholinergics, antipsychotics, benzodiazepines, and sedative-hypnotics—agents known to interfere with mentation and mobility. Using tools like the American Geriatrics Society Beers Criteria and anticholinergic burden calculators, pharmacists help deprescribe or recommend safer alternatives. For example, when a resident’s goal is to reduce fall risk, a pharmacist may recommend discontinuing a tricyclic antidepressant in favor of a non-sedating alternative.

Mentation: Pharmacists play a critical role in detecting and mitigating cognitive decline linked to medication side effects. By assessing drug regimens for agents known to exacerbate dementia or delirium, they can advocate for changes that preserve cognitive health, such as minimizing the use of multiple CNS-active agents in a resident with memory concerns.

Mobility: Medications can impact balance, gait, and strength. Pharmacists can reduce fall risk by avoiding medications linked to orthostatic hypotension, sedation, or dizziness. They can also collaborate with therapy staff to identify residents whose medications may be limiting participation in mobility programs

Application in Practice: From Dispensing to Decision-Making 

In dispensing roles, LTC pharmacists can embed the 4Ms into order verification processes by flagging potential problems at the point of fill. For example, if a newly prescribed medication poses a fall risk for a resident with recent fractures, that insight can be shared with the prescriber before the medication is dispensed.

Consultant pharmacists, on the other hand, have regular touchpoints with residents and care teams through medication regimen reviews, interdisciplinary meetings, and facility quality improvement initiatives. These reviews can be reframed as “4Ms check-ins” to ensure that medication regimens remain aligned with evolving care goals.

Pharmacists can also champion facility-wide adoption of the 4Ms through staff education, documentation practices, and participation in care transitions. For instance, improving discharge summaries to include 4Ms-related information can help ensure continuity of Age-Friendly care when transferring between settings.

Training and Recognition for Age-Friendly Pharmacists

The American Society of Consultant Pharmacists (ASCP), in partnership with the Lamy Center at the University of Maryland School of Pharmacy, offers a digital badge program recognizing pharmacists trained in the 4Ms framework. The program includes free online courses covering each of the 4Ms and is part of a national effort to train 2,500 pharmacists and bring Age-Friendly care into 950 LTC pharmacies.

By completing this training and earning the Age-Friendly Pharmacist badge, pharmacists signal their commitment to quality, person-centered care and gain tools to lead change within their organizations.

The Path Forward

Age-Friendly care is not a new layer of work—it’s a way to do the work we already do, better. Senior care pharmacists are already addressing medications, cognition, and mobility risks every day. Integrating the 4Ms gives structure to these efforts and elevates the pharmacist’s role as an essential member of the care team.

By championing the 4Ms, pharmacists can ensure that ‘What Matters’ most to residents truly drives their care, resulting in fewer adverse drug events, fewer hospitalizations, and better health outcomes and quality of life for older adults.

Nicole J. Brandt, PharmD, MBA, BCGP, FASCP
Professor and Executive Director, Lamy Center on Drug Therapy & Aging University of Maryland School of Pharmacy