'The five Ms' approach could optimize care for older adults

ByEmma Bascom

Fact checked byMindy Valcarcel, MS

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Key takeaways:

An ACP Internal Medicine Meeting presenter discussed a guide to caring for older adults, especially more complex cases.
The five Ms method includes multicomplexity, what matters, mind, mobility and medications.

NEW ORLEANS — Primary care providers should look to the five Ms as a guide to caring for older adults, according to Mary Tinetti, MD, a professor of geriatric medicine in Yale School of Medicine’s department of internal medicine, who spoke at the annual ACP Internal Medicine Meeting.

The five Ms stand for multicomplexity, what matters, mind, mobility and medications.

Dr. consulting senior couple — PCPs should consider the five Ms when making decisions for the care of older adults. *Image: Adobe Stock*

Tinetti told Healio that the five Ms comprise “an approach to decision-making and care that is based on our understanding of how to define optimal care” among older adults.

The first M — “and, I think, the defining M,” Tinetti said in her presentation — highlights that older adults with multicomplexity (defined as having complex life circumstances, multiple chronic conditions and functional limitations) do not benefit from having all of their chronic conditions treated separately, and “may be burdened and even harmed” by this approach.

“Deciding on treatments based on disease-specific outcomes is not appropriate when there are several competing conditions,” she told Healio.

The second M focuses on care planning and patients’ goals — or what matters. It highlights how patients “vary in the outcomes that matter most to them and in what they are willing and able to achieve,” Tinetti said.

The third M — mind — includes both cognition and mood. It asks the provider to consider dementia, depression, delirium and other conditions that influence one’s mental state. Conversely, the fourth M — mobility — asks the provider consider the patient’s physical function with fall prevention, gait and balance.

The final M, which again stands for medications, is “the most commonly prescribed intervention in medicine,” Tinetti said. When prescribing, providers should consider how the medicine might “positively or negatively affect the universal, cross-disease outcomes of mentation, mobility, what matters most to the individual, symptoms and survival.”

“The appropriate care for older adults with multicomplexity should move from treating each disease in isolation to determining what care to offer based on knowing what matters most to that individual, their overall health and their life circumstances,” Tinetti said. “The five Ms provide a framework for doing this.”

She said, rather than our current system of treating individual chronic conditions separately, it is both appropriate and feasible to start making decisions in a holistic way that views chronic condition management “through the lens of their effects” on the middle three Ms.

“Putting all of this together, we have developed, tested and are now implementing an approach to decision-making for older adults with multicomplexity that aligns care with the patient's specific, realistic and actionable goals — the ‘what matters most’ M — by first identifying these goals in a way that can inform decision-making and then considering the medical and socioeconomic and other factors impeding these goals, and selecting interventions to address these factors,” Tinetti said.

However, she also told Healio that she did not expect the audience members to entirely grasp the concept — “or even accept it” — based solely on one presentation.

“I hope it does pique their curiosity and heighten their awareness that this is an approach that can not only simplify and help focus their care but also result in better outcomes,” she said.