An Overview of the Age Friendly Structural Measure

The Age Friendly Hospital measure is a structural measure designed to assess and improve the quality of care for patients aged 65 and older in hospitals. It aims to ensure that hospitals provide high-quality, patient-centered care, focusing on improving outcomes and reducing risks associated with hospitalization. The measure is required under the Inpatient Quality Reporting (IQR) program and is essential for hospitals to demonstrate their commitment to providing age-friendly care.

When CMS rolled out this measure they cited 19 separate studies for justification of the importance of this measure. They believe that by focusing on the unique needs of older adults, they can help hospitals deliver personalized care which can improve overall outcomes and costs for this patient population.

CMS said that these studies prove that age-friendly practices can help reduce the length of hospital stays, which benefits both patients and providers. Shorter stays mean better outcomes and lower healthcare costs, making the care more efficient and cost-effective. The measure also emphasizes the effective management of older patients' conditions, which can prevent readmissions and minimize the risk of common complications, such as delirium and falls, thereby enhancing patient safety.

Download the Age Friendly Hospital Structural Measure Fact Sheet

Reporting and Attestation Requirements

• Reporting Year: The first mandatory reporting year for this measure is January 1 – December 31, 2025.
• Attestation Deadline: Hospitals must complete their attestation on this measure by May 15, 2026.
• Reporting System: The measure is reported through the CMS Hospital Quality Reporting (HQR) system.
• Compliance and Public Reporting: You must report this measure to ensure full IQR compliance. While your score on this measure won’t impact reimbursement, results will be publicly posted on Care Compare, which will influence patient choice and trust.

The Five Domains of the Age Friendly Hospital Measure

This programmatic measure evaluates a hospital's commitment to improving care for patients ≥ 65 years of age receiving services in the hospital, operating room (OR), or emergency department (ED).

The measure is structured into five key domains, each worth one point. Hospitals must attest to all statements within a domain to earn that point. You may attest “yes” when all domain components are met for the majority of patients ≥ 65.

The measure is worth five points, and your score will be displayed on Care Compare in a range from 0 to 5.

1. Domain 1: Eliciting Patient Healthcare Goals
   • Overview: Protocols to obtain, review, and document patient healthcare goals, and update them before major procedures and upon significant changes in clinical status.
   • Key Components: Regular discussions with patients and their families to understand their preferences and values, ensuring that care plans align with their goals.
   • Criteria for Attestation: The hospital must:
     1. Protocols for Obtaining and Reviewing Healthcare Goals:
        • Develop and implement protocols for obtaining and reviewing patient healthcare goals.
     2. Documentation of Healthcare Goals:
        • Document patient healthcare goals, including health goals, treatment goals, living wills, identification of healthcare proxies, and advance care planning, in the medical record.
     3. Updating Healthcare Goals:
        • Ensure that the patient healthcare goals are reviewed and updated before major procedures and upon significant changes in clinical status.
        • Document the updates in the medical record.
   • Domain Attestation Statements:
     1. Our hospital has protocols in place to ensure patient goals related to healthcare (i.e., health goals, treatment goals, living wills, identification of health care proxies, advance care planning) are obtained/reviewed and documented in the medical record. These goals are updated before major procedures and upon significant changes in clinical status.

2. Domain 2: Responsible Medication Management
   • Overview: Reviewing medications to identify potentially inappropriate medications (PIMs) for older adults, and considering discontinuation or dose adjustment as indicated, upon admission, before major procedures, and upon significant changes in clinical status.
   • Key Components: Regular medication reviews ensuring that medications are safe and effective for older adults.
   • Criteria for Attestation: The hospital must: 
     1. Medication Review:
        • Use standard evidence-based guidelines, criteria, or protocols to review medications.
        • Conduct medication reviews upon admission, before major procedures, and upon significant changes in clinical status.
        • Document the results of medication reviews in the medical record.
     2. Identifying PIMs:
        • Identify potentially inappropriate medications (PIMs) for older adults using validated tools and guidelines.
     3. Discontinuation and/or Dose Adjustment
        1. Consider discontinuing or adjusting the dose of identified PIMs as indicated.

2. • Domain Attestation Statements:
     1. Our hospital reviews medications for the purpose of identifying potentially inappropriate medications (PIMs) for older adults as defined by standard evidence-based guidelines, criteria, or protocols. Review should be undertaken upon admission, before major procedures, and/or upon significant changes in clinical status. Once identified, PIMs should be considered for discontinuation and/or dose adjustment as indicated.

3. Domain 3: Frailty Screening and Intervention
   • Overview: Screening patients for risks related to cognitive impairment/delirium (mentation), physical function (mobility), and malnutrition using validated instruments, and creating management plans based on positive screens.
   • Key Components: Using standardized screening tools, developing personalized care plans, and collecting data on falls, decubitus ulcers, and 30-day readmissions.
   • Criteria for Attestation: The hospital must:
     1. Screening for Risks:
        • Use validated instruments to screen patients for cognitive impairment/delirium, mobility, and malnutrition.
        • Conduct screenings upon admission, before major procedures, and upon significant changes in clinical status.
        • Document screening results in the medical record.
     2. Creating Management Plans:
        • Utilize positive screens to create management plans addressing identified risks.
        • Include strategies to minimize delirium risks, encourage early mobility, and implement nutrition plans.
        • Include management plans in discharge instructions and communicate them to post-discharge facilities.
     3. Data Collection and Analysis:
        • Collect data on falls, decubitus ulcers, and 30-day readmissions for patients aged 65 and older.
        • Stratify data by sex/gender, race, age, and ethnicity.
     4. Reducing Emergency Department Delirium:
        • Document and implement protocols to reduce the length of emergency department stay for older patients.
        • Aim to transfer a targeted percentage of older patients out of the emergency department within 8 hours of arrival and/or within 3 hours of the decision to admit.
   • Domain Attestation Statements:
     1. Our hospital screens patients for risks regarding mentation (mental activity), mobility, and malnutrition using validated instruments, ideally upon admission, before major procedures, and/or upon significant changes in clinical status.
     2. Our hospital utilizes positive screens to create management plans, including but not limited to minimizing delirium risks, encouraging early mobility, and implementing nutrition plans where appropriate. These plans should be included in discharge instructions and communicated to post-discharge facilities.
     3. Our hospital collects data on the rate of falls, decubitus ulcers, and 30-day readmissions for patients ≥65. These data are stratified by sex/gender, race, age, and ethnicity.
     4. Our hospital has protocols to reduce the risk of emergency department delirium by reducing length of emergency department stay with a goal of transferring a targeted percentage of older patients out of the emergency department within 8 hours of arrival and/or within 3 hours of the decision to admit.

4. Domain 4: Social Vulnerability
   • Overview: Screening older adults for geriatric-specific social vulnerability, including social isolation, economic insecurity, limited access to healthcare, caregiver stress, and elder abuse, and addressing these issues through intervention strategies and appropriate referrals.
   • Key Components: Identifying and addressing social determinants of health to ensure that older patients' social needs are met.
   • Criteria for Attestation: The hospital must:
   • Screening for Social Vulnerability:
     1. Use validated tools and protocols to screen older adults for social isolation, economic insecurity, limited access to healthcare, caregiver stress, and elder abuse.
     2. Perform these assessments upon admission and again prior to discharge.
     3. Document the results of the screenings in the medical record.
   • Utilizing Positive Screens for Intervention:
     1. Develop and implement intervention strategies for patients who screen positive for social vulnerability.
     2. Ensure that intervention strategies are tailored to the specific needs of each patient and include referrals and resources as applicable.
     3. Document and communicate any applicable referrals and resources to the patient upon discharge.
   • Domain Attestation Statements:
     1. Our hospital screens older adults for geriatric-specific social vulnerability, including social isolation, economic insecurity, limited access to healthcare, caregiver stress, and elder abuse to identify those who may benefit from care plan modification. Assessments are performed on admission and again prior to discharge.
     2. Our hospital utilizes positive screens for social vulnerability (including those that identify patients at risk of mistreatment) and addresses them through intervention strategies. These strategies should include appropriate referrals and resources for patients upon discharge.

5. Domain 5: Age-Friendly Care Leadership
   • Overview: Designating a point person or interprofessional committee to ensure age-friendly care issues are prioritized, compiling quality data related to the Age Friendly Hospital measure, and using this data to drive improvement cycles.
   • Key Components: Leadership commitment to age-friendly care; regular meetings to discuss and address issues, and the development of policies and procedures to support age-friendly practices.
   • Criteria for Attestation: The hospital must:
     1. Designation of a Point Person or Interprofessional Committee:
        • Identify and appoint a specific individual or committee responsible for age-friendly care.
        • Ensure that this individual or committee has the authority and resources to oversee age-friendly care initiatives, including quality related to older patient care.
        • Identify opportunities to provide education to staff.
        • Update hospital leadership on needs related to providing age-friendly care.
     2. Compilation and Use of Quality Data:
        • Collect and compile quality data related to the Age Friendly Hospital measure.
        • Stratify the data by sex/gender, race, age, and ethnicity.
        • Use the stratified data to identify trends, develop targeted improvement cycles, and monitor the effectiveness of initiatives.
   • Domain Attestation Statements:
     1. Our hospital designates a point person and/or interprofessional committee to specifically ensure age-friendly care issues are prioritized, including those within this measure. This individual or committee oversees such things as quality related to older patients, identifies opportunities to provide education to staff, and updates hospital leadership on needs related to providing age-friendly care.
     2. Our hospital compiles quality data related to the Age Friendly Hospital Measure. These data are stratified by sex/gender, race, age, and ethnicity, and should be used to drive improvement cycles.

Best Practices to Implement the Age Friendly Hospital Measure

The Age Friendly Hospital Measure requires focusing on a couple key factors:

• Developing protocols for obtaining and updating patient healthcare goals
  • Establish protocols for obtaining and reviewing patient healthcare goals, including health goals, treatment goals, living wills, identification of healthcare proxies, and advance care planning. Update these goals before major procedures and upon significant changes in clinical status.
• Ensuring proper medication management
  • Regularly review medications to identify and manage potentially inappropriate medications using standard evidence-based guidelines and validated tools. Communicate any changes to the patient and the healthcare team.
• Performing screenings for risks and social vulnerabilities

• • Screen patients for risks related to cognitive impairment, physical function, and malnutrition using validated instruments. Create personalized management plans based on the results of these screenings.
  • Use validated tools to assess for social isolation, economic insecurity, caregiver stress, and elder abuse. Develop tailored intervention strategies to address these issues.
• Designating leadership to oversee the program
  • Designate a point person or an interprofessional committee to oversee age-friendly care initiatives. Ensure they have the authority and resources needed to implement and monitor these initiatives. Use quality data to drive improvement cycles and ensure all criteria are met.

Remember that in order to get a point for the domain, you must attest “yes” to each of the statements within the domain. And to say “yes” means that the practices are done for the majority of patients aged 65 and older.

Other Resources

As of the date of publication of this article, CMS has not released many resources for this new structural measure, but I’ve added a few links for you to have on hand. CMS will update QualityNet with more resources in the future.

Measure Specification: https://qualitynet.cms.gov/files/66ac087f86c07e0c5ec5e936?filename=AFH_MeasSpecs_FinalRule.pdf

Structural Measure Website: https://qualitynet.cms.gov/inpatient/iqr/measures#tab2