Geriatric 5Ms™

The Primary Health Care Integrated Geriatric Services Initiative (PHC IGSI, pronounced fig-see) is work underway in Alberta to support older Albertans living with cognitive impairments, and/or complex care needs and their carers who live in the community. The aim of PHC IGSI is to connect people living with dementia to age and live well. This initiative is led by two Alberta Health Services Strategic Clinical Networks (SCNs) – the Seniors Health SCN and the Primary Health Integration Network. These two SCNs support point-of-care teams from seven communities to increase capacity within a primary health care model to provide timely, accessible and ongoing support for those living in the community with mild cognitive impairment, dementia, frailty or other geriatric syndromes. PHC IGSI and the participating teams work have incorporated the Geriatric 5Ms© framework into their practice in the following ways: - At the provincial level (Macro): o As a framework to share with participating teams to assist them in planning care and support for those living in their communities. These teams include membership from health and social sectors, as well as community partners and members of the public. o To structure the second of four learning workshops. - - At the community level (Meso): o Community teams are using the 5Ms© to frame conversations with local partners from health and social sectors, and members of the public about what “Matters Most” to people living with dementia and their carers, in order that their local communities can develop new primary health care supports. This includes understanding what unmet needs there may be in the community, planning for how to work together to meet the need, and to identify educational needs that may support achieving those plans. o Use of the 5Ms© in combination with the notion of an integrated health system align to support teams in understanding that planning care for those living in the community necessitates a broad, inclusive primary health care approach. At the individual level (Micro): o Teams have built the 5Ms© Framework into their clinic electronic medical record. The elements of the 5Ms© help guide providers during clinic visits. o One team has incorporated the elements of the 5Ms© into a care and support plan that is co-designed with members of the primary clinic team, and the individual patient and or their family. Focusing on the “Matters Most” section offers guidance into what next steps are for the individual and/or their care partners. A copy of this care and support plan is given to the individual and their family to share with other providers or services they are accessing. For more information on the PHC IGSI work and to access presentations and videos from learning workshops, please go to the PHC IGSI website. If you would like to learn more from the teams participating in PHC IGSI, please contact us at seniorshealth.scn@ahs.ca

I was introduced to the 5 M’s concept during my Geriatric Fellowship at the University of Ottawa shortly after it was developed there by my mentors at the time, Drs. Molnar and Huang. I instantly recognized the utility in distilling the complex work of Geriatricians into a simple and memorable acronym. Suddenly my patients and trainee colleagues in other fields knew what it is Geriatricians do! I have since completed fellowship and now practice as an Internist and Consultant Geriatrician in Moncton, New Brunswick and the 5 M’s have travelled east with me. Here in New Brunswick, our group has structured our outpatient referral form around this acronym, allowing referring physicians the opportunity to describe which of the M’s they would like addressed with their patients during the consult. 

The 5 M’s have found other uses in Moncton as well:

• I frequently include a 5 M’s slide at the beginning of my presentations at grand rounds and when teaching students/residents to orient the audience to what it is we do it Geriatric Medicine. 

• I structure inpatient progress notes using the 5 M’s as a template and encourage learners working with me to do the same.

• Frequently, I have structured family conferences around the 5 M’s; not only to ensure that all pertinent Geriatric issues are addressed, but also to make sure the focus remains on the 5th M – “What Matters most”, which I have found is an excellent way to initiate conversations around advanced care planning.

Sincerely,

Dr. M. Jason MacDonald, MD, FRCPC

Members of the Division of Geriatrics and Palliative Care, VA Boston Healthcare System have developed a workshop based around the GERIATRIC 5Ms that maps to the current Accreditation Council for Graduate Medical Education (ACGME) core competencies in geriatrics for internal and family medicine residents. Analysis demonstrated that this longitudinal, interactive, case-based workshop using the GERIATRIC 5Ms framework improved primary care residents’ self-efficacy and knowledge of tools in the care of older adults and geriatric competencies outlined by the ACGME. The workshop offers an innovative and efficient method to teach geriatrics to residents in primary care and prepare them to care for an aging population. To learn more please access the report at https://www.mededportal.org/publication/10814/.