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Dr. Carter H. Davis. Christine E. Gould, PhD, ABPP-gero; and Susan K. Schultz, MD
Publication date: October 3, 2024
The Age-Friendly Health Systems Movement 1 promotes four evidence-based geriatric care principles known as the “4Ms”: What Matters, Medication, Mobility, and Mentation 2 . These principles reflect a shift from problem-focused care to recognition of the interaction of factors. Contributes to the quality of life and health of the elderly. Mental health professionals such as psychiatrists, psychologists, psychiatric nurses, clinical psychiatric pharmacists, certified professional counselors, and social workers play an important role in the treatment of older adults who benefit from age-sensitive care. I am. Our case highlights the role of mental health clinicians in implementing each element of the 4Ms.
case report
Mr. A is an 82-year-old man whose wife has concerns about decreased motivation and activity (which was surprising since Mr. A used to be very adventurous and flew small planes), sleep disturbances, and sleep disturbances. Because of this, I visited a mental health outpatient clinic. Frequent irritability. Mr. A recently enrolled with the Veterans Health Administration due to increasing medical concerns, including hypertension, hyperlipidemia, abdominal aortic aneurysm status following endoscopic repair, and prostatic hypertrophy. He was also recently diagnosed with subcortical vascular cognitive disorder. Imaging revealed extensive nonspecific microvascular white matter disease bilaterally with symmetrical atrophy.
mentation. Within the domain of mentation, clinicians aim to identify and treat mood-related and cognitive conditions such as dementia, depression, and delirium (Table 1). In our case, there were elements of both cognitive decline (dementia) associated with vascular changes and mood manifestations that can be conceptualized as “vascular depression.” It not only addresses mood issues but also slows down the progression of cognitive changes in some individuals. 20 Low-dose SSRIs were well tolerated by Mr. A, who reported significant improvements in function, including willingness to go for daily walks.
Mobility. The ability to engage in physical activity through proper gait and balance while avoiding falls promotes improved vascular health and mood (see Table 1). A multicenter study 21 of approximately 800 older adults using accelerometer data demonstrated that a 10% increase in physical activity was associated with significant improvements in mood symptoms. In Mr. A’s case, encouraging physical activity may help manage his subcortical vascular condition.
medicine. The nature of cognitive changes in subcortical ischemic disease includes difficulties with executive function (planning and estimating the consequences of actions) and motivation, which may impact medication management and health status monitoring. Yes (see Table 1). For Mr. A, this includes managing and refilling medications and self-monitoring blood sugar and blood pressure. In addition, potential side effects of medications (both prescription and over-the-counter) in older adults, including those that may reduce cognitive function, should be carefully monitored (see Table 1).
What is important? People with vascular-related cognitive decline face barriers in establishing viable and safe priorities in health care and lifestyle management. Clinicians need to identify what is most important to patients and connect those values to specific and appropriate actions that impact health (see Table 1). The clinician can discuss the values underlying Mr. A’s love of aviation (adventure, freedom, mastery) and identify viable activities that reflect these attributes (such as taking a cruise or , watching planes fly in and out of your local airport). Considering patient preferences and values can also lead to discussions about advance care planning.
conclusion
The age-friendly health care system movement is redesigning health care in all settings, from outpatient to inpatient to long-term services, to proactively care for older adults and align the delivery of health care services with individual health. The purpose is to align with your goals and values. 2 Therefore, this is essential. Mental health clinicians should not only incorporate the 4Ms into their own care, but also consider their role as change agents within clinics and medical settings that disseminate these practices.
Article information
Published online: October 3, 2024. https://doi.org/10.4088/PCC.24cr03780
© 2024 Physicians Postgraduate Press, Inc.
Primcare Companion CNS Disease 2024;26(5):24cr03780
Submission date: May 26, 2024. Accepted on July 24, 2024.
Citation: Davis CH, Gould CE, Schultz SK. Age-friendly health systems: The relationship between medicine and mental health. Primcare companion CNS disease. 2024;26(5):24cr03780.
Author affiliation: Psychology Service, VA Palo Alto Health Care System, Palo Alto, California (Davis). Geriatric Research Education and Clinical Center, Palo Alto Healthcare System, Virginia, Palo Alto, California (Gould). Department of Psychiatry and Behavioral Sciences (Gould), Stanford University School of Medicine, Palo Alto, California. VISN 23 Clinical Resource Hub, Veterans Health Administration, Minneapolis, MN (Schultz). Dr. Gould and Dr. Schultz contributed equally to this study.
Corresponding author: Carter H. Davis, Ph.D., Office of Psychology, Veterans Affairs Palo Alto Health System, 3801 Miranda Ave, Palo Alto, CA 94304 ((email protected)).
Relevant financial relationships: None.
Funding/Support: None.
Patient Consent: Verbal consent was obtained to publish the case report and patient information will not be identified to protect anonymity.
Disclaimer: The views expressed in this article are those of the author and not necessarily those of the Department of Veterans Affairs or the federal government.
ORCID: Carter H. Davis: https://orcid.org/0000-0002-3142-4784
