After years of working to improve care for older adults at MinuteClinic, the retail medical clinics inside select CVS Pharmacy stores across the U.S., Case Western Reserve University’s Frances Payne Bolton School of Nursing has earned a three-year, $2.57 million grant from The John A. Hartford Foundation to expand these age-friendly practices to primary care settings.
Building on the progress of three earlier phases of the Age-Friendly Health Systems initiative, this new three-year grant for phase four brings The John A. Hartford Foundation’s total commitment since 2018 to approximately $8.41 million. “The Age-Friendly Health Systems movement aims to reach older adults with age-friendly care wherever they seek care,” said Rani E. Snyder, MPA, president of The John A. Hartford Foundation. “This collaboration between Case Western Reserve University, MinuteClinic and other partners plays a critical role in the movement by expanding age-friendly care across convenient and primary care settings nationwide.”
“We are incredibly grateful that The John A. Hartford Foundation has invested in us for four grant cycles,” said Mary Dolansky, PhD, RN, the Sarah C. Hirsh Professor at Frances Payne Bolton School of Nursing and the project's co-principal investigator. “This long-term commitment—which began with a pre-doctoral award that supported my early training in geriatrics—has allowed our team to design, test, scale and now extend the Age-Friendly model from convenient care [in MinuteClinic locations] to comprehensive primary care settings.”
The 4Ms Framework
The initiative promotes the 4Ms Framework, an evidence-based model designed to improve care for older adults. The framework centers on four core pillars:
- What Matters: Aligning clinical treatment directly with an individual’s personal goals and priorities.
- Medication: Reviewing prescriptions to ensure they are safe, necessary and age-appropriate.
- Mentation: Actively screening for and managing dementia, depression and delirium.
- Mobility: Supporting safe physical movement to help older adults maintain independence.
“Age-friendly care starts by asking older adults what matters most to them and then matching their medications, mentation and mobility to support those goals,” said Dolansky.
In practice, this means clinicians screen older patients during routine office visits. For example, asking patients about personal life goals, conducting rapid memory and mobility checks, and reviewing prescriptions to eliminate drugs that cause confusion or increase fall risk.
“The John A. Hartford Foundation’s sustained support positions the Frances Payne Bolton School of Nursing to make age-friendly care a national standard in primary care, where innovation is urgently needed to meet the needs of a rapidly growing older population,” said Ronald Hickman, PhD, RN, Dean and Ruth M. Anderson Professor of the Frances Payne Bolton School of Nursing. “This is innovation at scale. Building on our work across CVS MinuteClinic sites nationwide, we will equip primary care teams to reduce preventable hospitalizations, identify medication and cognitive risks, preserve independence and ensure that care reflects what matters most to older adults.”
Pivot to primary care
With this newest support from The John A. Hartford Foundation, the fourth phase of the initiative, which runs through 2029, will focus on primary care to help address the national shortage of geriatric specialists. According to the American Academy of Pediatrics and the American Geriatrics Society, there are about 36,000 pediatricians in the United States, compared to approximately 7,000 geriatricians.
This expansion is backed by clinical evidence showing that age-friendly care delivers measurable results. Research led by Nicholas Schiltz, PhD, assistant professor, co-principal investigator, demonstrated key outcomes for patients receiving 4Ms care:
- Reduced hospitalizations: Patients receiving complete 4Ms care showed a 6.9% lower rate of inpatient hospitalization.
- Enhanced follow-up: Older adults were 1.34 times more likely to visit a primary care provider within 30 days when recommended through the 4Ms framework.
- Identifying invisible risks: The database identified a 4.5% high anticholinergic medication burden in patients—a cognitive risk factor often missed.
To bring these proven outcomes to primary care providers and address the heavy workloads, CWRU is launching a National Primary Care Learning Network. Over the next three years, the CWRU team will work directly with MinuteClinic and health systems—including Dartmouth Health in New Hampshire and the U.S. Department of Veterans Affairs—to embed 4Ms screening prompts directly to electronic health records, train interdisciplinary care teams and streamline clinic workflows to standardize senior care without adding time to doctor visits.
Advancing curriculum
The John A. Hartford Foundation's investment is also shaping education at CWRU. The 4Ms Framework is now taught in nursing courses and integrated into medical school initiatives that pair students with older adults in their homes. Students also participate directly on the research team, creating a feedback loop between education and practice.
“If our work raises awareness of ageism and helps society focus on what matters to older adults, that is a tremendous success,” Dolansky said.
Learn more about The John A. Hartford Foundation:
The John A. Hartford Foundation, based in New York City, is a private, nonpartisan philanthropy dedicated to improving the care of older adults. The leader in the field of aging and health, the foundation has three priority areas: creating age-friendly health systems, supporting family caregivers and improving serious illness and end-of-life care. For more information, visit www.johnahartford.org.
