# Implementing the Age-Friendly Health System in VHA: using evidence-based practice to improve outcomes in older adults

> **NIH VA I50** · PHILADELPHIA VA MEDICAL CENTER · 2021 · —

## Abstract

There are currently more than 4 million Veterans aged 65 and older, yet the VA is not yet optimized to
provide them with the most consistent, highest quality care. A large body of research shows that inappropriate
care and unmet care needs among older adults accelerates cognitive and functional decline and increases
medical harms, leading to poorer quality of life, more frequent hospital utilization, and premature nursing home
admission. In VISN 4, 62% of the approximately 275,000 enrolled Veterans are aged 65 or older, and
hospitalization and long-term institutionalization rates vary substantially across VISN 4 and the VA nationally.
 The Institute of Healthcare Improvement and John A. Hartford Foundation recognized addressing
persistent patient safety gaps in care for older adults will require a systematic approach, and are leading a
national campaign to make all health systems “Age-Friendly.” This movement emphasizes four “M”s that must
be addressed synergistically: 1) what Matters (i.e., attending to each person’s goals and preferences); 2)
avoiding harms related to Medication; 3) preventing, identifying, treating, and managing cognitive impairment
(Mentation); and 4) promoting safe movement to maintain function and independence (Mobility). Although the
VA is not one of the hundreds of health systems making the transformation to being “Age-Friendly,” this
transition is directly aligned with VHA priorities, including VHA modernization (e.g., commit to zero-harm), VHA
network and medical center director performance plan goals (e.g., spreading evidence-based practices), and
public benchmarks (e.g., reducing hospitalization rates).
 Shifting to an Age-Friendly Health System will require implementing evidence-based practices (EBPs)
that address the four “M’s,” training Age-Friendly Health System leaders, and building sustainable operational
networks. Our QUERI program is built around five core functions to accomplish these goals: 1) an
Implementation Core that will rigorously test implementation strategies; 2) a Methods Core that will evaluate
quantitative and qualitative outcomes, including a return-on-investment analysis; 3) a Mentoring Core that will
help train future leaders at the crucial intersection of geriatrics and implementation science; 4) a Rapid
Response Team that will address the operational needs of stakeholders; and 5) a Technical Expert Panel
including leaders in Age-Friendly initiatives, Veterans, and VA local and national leadership.
 We will focus on four EBPs, each addressing one of the four “M’s”: 1) a preoperative screening and
referral tool to ensure the goals of surgery are aligned with the personal goals of frail older adults that reduces
operative mortality (What Matters); 2) a direct-to-consumer intervention with demonstrated efficacy in
discontinuing high-risk medications among older adults (Medications); 3) an intervention that improves the
ability of functionally impaired older Veterans to age in place (Mobility); an...

## Key facts

- **NIH application ID:** 10070381
- **Project number:** 1I50HX003201-01
- **Recipient organization:** PHILADELPHIA VA MEDICAL CENTER
- **Principal Investigator:** Robert Edward Burke
- **Activity code:** I50 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2020-10-01 → 2025-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10070381

## Citation

> US National Institutes of Health, RePORTER application 10070381, Implementing the Age-Friendly Health System in VHA: using evidence-based practice to improve outcomes in older adults (1I50HX003201-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10070381. Licensed CC0.

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