5Ms
Geriatric medicine focuses on the unique health needs of older adults, a population segment that is rapidly growing worldwide. While specialized geriatricians play a crucial role, the majority of older adults receive care from non-specialist doctors. To equip these clinicians with a foundational understanding of geriatric care, the Geriatric 5Ms framework has emerged as a widely adopted and effective tool [1, 9]. This framework provides a person-centered approach to address the complex and often interconnected health challenges faced by older individuals.
The 5Ms stand for Mind, Mobility, Medications, Multicomplexity, and What Matters Most. This article will delve into each of these components, explaining their significance and offering practical considerations for non-specialist doctors in their daily practice.
1. Mind: Cognition, Mood, and Delirium
Mind encompasses an older adult's cognitive function, mood, and the presence of conditions like delirium. Cognitive impairment, ranging from mild cognitive impairment to dementia, is prevalent in older populations and significantly impacts daily functioning and quality of life [6]. Depression and anxiety are also common and often underdiagnosed in older adults.
Key Considerations for Non-Specialists:
• Screening: Regularly screen for cognitive impairment using simple tools like the Mini-Cog or the Montreal Cognitive Assessment (MoCA). Be aware of subtle changes in memory or behavior reported by patients or their families.
• Mood Assessment: Inquire about symptoms of depression and anxiety. Remember that depression in older adults can present atypically, with more somatic complaints and less overt sadness.
• Delirium Awareness: Be vigilant for delirium, an acute change in attention and cognition, especially in hospitalized or acutely ill older patients. Delirium is a medical emergency and often indicates an underlying acute illness [6].
• Environmental Factors: Recognize how environmental factors (e.g., sensory impairment, unfamiliar surroundings) can impact an older adult's cognitive and emotional well-being.
2. Mobility: Movement, Falls, and Function
Mobility refers to an older adult's ability to move safely and independently, encompassing gait, balance, and functional status. Impaired mobility is a major predictor of falls, loss of independence, and increased morbidity and mortality [9].
Key Considerations for Non-Specialists:
• Gait and Balance Assessment: Observe the patient's gait and balance during routine visits. Simple tests like the Timed Up and Go (TUG) test can provide valuable insights into fall risk.
• Fall Prevention: Proactively address fall risk factors, including polypharmacy, visual impairment, orthostatic hypotension, and environmental hazards. Encourage regular physical activity tailored to the patient's abilities.
• Functional Status: Assess the patient's ability to perform Activities of Daily Living (ADLs) such as bathing, dressing, and eating, and Instrumental Activities of Daily Living (IADLs) like managing medications, finances, and transportation. Declines in these areas can signal underlying health issues.
• Assistive Devices: Consider and recommend appropriate assistive devices (e.g., canes, walkers) to enhance safety and independence.
3. Medications: Polypharmacy, Deprescribing, and Adverse Drug Events
Medications is a critical M, given that older adults often take multiple medications (polypharmacy), increasing their risk of adverse drug events (ADEs), drug-drug interactions, and medication non-adherence [4].
Key Considerations for Non-Specialists:
• Medication Review: Conduct a thorough medication review at every visit, including over-the-counter drugs, supplements, and herbal remedies. Ask patients to bring all their medications to appointments.
• Deprescribing: Actively consider deprescribing, the process of safely reducing or stopping medications that may be causing harm or are no longer beneficial. Tools like the Beers Criteria can help identify potentially inappropriate medications for older adults [4].
• Adverse Drug Events (ADEs): Be aware of common ADEs in older adults, which can manifest atypically (e.g., confusion, falls). Educate patients and caregivers about potential side effects.
• Medication Adherence: Address factors affecting medication adherence, such as cost, complexity of regimen, cognitive impairment, and lack of understanding.
4. Multicomplexity: Comorbidities, Geriatric Syndromes, and Social Determinants
Multicomplexity acknowledges that older adults often present with multiple chronic conditions (comorbidities), geriatric syndromes (e.g., frailty, incontinence, pressure ulcers), and are significantly impacted by social determinants of health (e.g., socioeconomic status, living environment, social support) [9].
Key Considerations for Non-Specialists:
• Holistic Assessment: Adopt a holistic approach that considers the interplay between physical, mental, and social factors. Recognize that managing one condition can impact others.
• Geriatric Syndromes: Be familiar with common geriatric syndromes and their impact on overall health and function. These often do not fit neatly into single disease categories.
• Social Determinants of Health: Inquire about the patient's living situation, social support network, financial stability, and access to resources. These factors profoundly influence health outcomes and care plans.
• Care Coordination: Recognize the importance of coordinating care with other healthcare professionals, caregivers, and community resources.
5. What Matters Most: Patient Goals, Values, and Preferences
What Matters Most emphasizes the importance of understanding and prioritizing the older adult's personal goals, values, and preferences for their care. This principle ensures that medical decisions align with the patient's wishes and promotes person-centered care [9].
Key Considerations for Non-Specialists:
• Open Communication: Engage in open and empathetic conversations with older adults and their families about their priorities, fears, and hopes for their health.
• Advance Care Planning: Discuss advance directives, power of attorney for healthcare, and end-of-life wishes. Document these discussions and ensure they are accessible.
• Shared Decision-Making: Involve the patient in decision-making processes, respecting their autonomy and preferences, even when these differ from conventional medical recommendations.
• Quality of Life: Prioritize interventions that enhance quality of life and align with the patient's definition of well-being, rather than solely focusing on disease-specific outcomes.
Conclusion
The Geriatric 5Ms framework provides a practical and comprehensive lens through which non-specialist doctors can approach the care of older adults. By systematically considering Mind, Mobility, Medications, Multicomplexity, and What Matters Most, clinicians can move beyond a disease-centric model to deliver truly person-centered, age-friendly care. Integrating these principles into routine practice will not only improve the health outcomes and quality of life for older patients but also empower non-specialist doctors to confidently address the unique challenges of geriatric medicine.
References
[1] Tinetti, M., Huang, A., & Molnar, F. (2017). The Geriatrics 5M’s: A New Way of Communicating What We Do. Journal of the American Geriatrics Society, 65(9), 1891–1894. https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.14979 [4] Monette, P. J., & Schwartz, A. W. (2023). Optimizing Medications with the Geriatrics 5Ms: An Age-Friendly Approach. Drugs & Aging, 40(5), 415–424. https://pmc.ncbi.nlm.nih.gov/articles/PMC10092911/ [6] Sohn, B. C. (2024). Clinician’s Guide to Geriatric Assessment. Mayo Clinic Proceedings. https://www.mayoclinicproceedings.org/article/S0025-6196(24)00417-8/fulltext [9] Jamshed, N. (2024). Prioritizing the 5Ms in Geriatric Care: A Holistic Approach. American Family Physician, 109(6), 577-578. https://www.aafp.org/pubs/afp/issues/2024/0600/editorial-holistic-approach-geriatric-care.html
