The health care landscape is shifting rapidly, and it is more evident in the care of older adults. By 2030, one in five Americans will be over 65, and most will be living with multiple chronic conditions. Yet the health care system—still optimized for single-disease management—is not keeping pace in geriatric medicine.
According to Mayo Clinic Proceedings (2024), managing chronic disease in older adults requires more than following traditional guidelines. It demands a shift in mindset: from “what’s the matter with the patient” to “what matters to the patient.” This is where the Geriatric 5Ms come into Geriatric Medicine Board Review—a simple yet powerful framework to help clinicians navigate the realities of aging.
The 5Ms: A Practical Framework for Geriatric Medicine
The Geriatric 5Ms—Mind, Mobility, Medications, What Matters Most, and Multicomplexity—address the full range of aging-related health concerns that traditional disease-focused care often misses.
These domains are not academic concepts; they’re practical tools for managing the complex interplay of chronic illness, function, cognition, and personal goals.
Let’s break them down.
Mind: Cognitive and Emotional Health
Cognitive impairments, such as dementia and delirium, affect nearly 30% of people over 85. Yet dementia is underdiagnosed, often leading to late-stage interventions that compromise autonomy and safety.
Screening tools like the Mini-Cog, MoCA, and PHQ-9 can be administered in under 15 minutes and offer valuable insights into a patient’s ability to manage their health. Cognitive decline often affects medication adherence, planning ability, and decision-making, making early identification essential.
Key stat: Over 50 million people worldwide are currently living with dementia, a number projected to triple by 2050.
Mobility: The Foundation of Independence
Mobility is directly tied to quality of life and survival. Falls are the leading cause of injury-related death among older adults. Tools like the Timed Up and Go (TUG) Test, 4-Stage Balance Test, and the STEADI toolkit help identify fall risks before they result in hospitalization.
Clinician Tip: If your patient takes longer than 12 seconds on the TUG test or struggles with tandem standing for 10 seconds, they’re at increased risk of falls and functional decline.
Addressing mobility means more than recommending a cane—it means referring to physical therapy, deprescribing sedating medications, and addressing vision, footwear, and environmental risks (P-SCHEME).
Medications: Less Is Often More
Older adults represent 33% of prescription use and 40% of non-prescription drug use, despite being only 16% of the population. Polypharmacy, the use of 5+ medications simultaneously, is common and often dangerous.
The Mayo Clinic authors warn of the “prescribing cascade,” where one drug’s side effects lead to new prescriptions, increasing risks and complexities. Using deprescribing frameworks, the Beers Criteria, and tools like STOPP/START, clinicians can reduce adverse drug events and simplify regimens.
Fact: The three most dangerous drug classes for older adults are anticoagulants, antidiabetic agents, and opioids.
What Matters Most: Aligning Care with Values
Older adults may value function over longevity, independence over intervention, and comfort over cure. But these priorities often get lost in medical encounters.
Advance Care Planning (ACP) is crucial but underused. The Mayo article recommends structured conversations using frameworks like REMAP or SPIKES, along with POLST documentation, to ensure care aligns with patient goals.
As people near the end of life, nearly 70% lose the ability to make their own medical decisions. Without Advance Care Planning (ACP), their wishes might never be known or honored.
Multicomplexity: Beyond Medical Diagnoses
Older adults often face a web of medical, functional, and social challenges, termed multicomplexity. This includes multiple chronic diseases, and social indicators like poverty, housing insecurity, transportation barriers, and caregiver strain.
260 out of every 1,000 adults over 80 live with multimorbidity, and a third of older Americans are net-worth poor.
The key is holistic care: addressing both the disease and the lived experience. This means routinely assessing activities of daily living (ADLs) and instrumental activities of daily living (IADLs), supporting caregivers, and connecting patients with community-based resources.
Why the 5Ms Matter in Geriatric Medicine Chronic Care
Most older adults see a primary care clinician, not a geriatrician. The shortage of geriatricians, which is only 1 per 10,000 older adults, means PCPs need to be fluent in age-sensitive care.
The Geriatric 5Ms don’t replace specialty care; they enhance everyday practice, especially in chronic condition management.
They help clinicians:
- Spot early signs of decline
- Adjust medications for safety and simplicity
- Improve adherence and quality of life
- Center care around what patients actually need
Case Study: When Guidelines Collide with Geriatric Medicine Reality
Let’s consider one of the standard regimens for managing heart failure and hypertension in a 55-year-old: an ACE inhibitor, a beta blocker, and a diuretic. However, this combination can be problematic for an 84-year-old with chronic kidney disease, orthostatic hypotension, and a history of falling. The beta blocker will blunt a heart rate response to hypotension, and diuretics can worsen chronic kidney disease by decreasing GFR. Finally, this combination can aggravate orthostasis, thereby causing falls with significant injury.
A geriatric-informed PCP recognizes the risks and moves from aggressive disease control towards managing functional outcomes and patient-centred goals.
A different approach yields visibly different results –fewer hospitalizations, improved independence, and higher patient satisfaction.
What the Research Shows: Better Outcomes with Geriatric-Informed Care
A systematic review published in JAMA Internal Medicine found that comprehensive geriatric assessments— including medication reviews, functional testing, and coordinated care planning—reduce 30-day hospital readmissions and improve long-term outcomes.
Another article recommends incorporating functional, cognitive, and psychosocial assessments in chronic care to improve diagnostic accuracy. This will help achieve patient goals and offset the occurrence of adverse drug events.
This is especially important in transitions of care, which entail medication changes, and where poor communication often causes conditions to get worse.
From Theory to Practice: Next Steps for Clinicians
Integrating the 5Ms doesn’t require overhauling your clinic. It starts with small, consistent changes:
- Use brief cognitive or mobility screens during chronic care visits
- Review medications for side effects and necessity
- Ask: “What are your biggest goals for your health?”
- Involve caregivers early and often
If you’re ready to take the next step, the Geriatric Medicine Board Review course offers deep-dive training, resources, and CME credit. You’ll learn how to:
- Perform rapid geriatric assessments
- Recognize common atypical presentations in older patients
- Navigate complex medication regimens
- Align care plans with patient values
- Lead more effective, collaborative care teams
Close the Gap in Care with Our Geriatric Medicine Board Review
Chronic care in older adults isn’t just more—it’s different. With the Geriatric 5Ms, clinicians can provide thoughtful, efficient, patient-centered care that improves function and reduces harm.
Whether you work in outpatient clinics, hospital wards, or transitional care settings, our Geriatric Medicine Board Review Course equips clinicians with the knowledge and skills to deliver safe, effective, and compassionate care to aging patients.
This CME-accredited program not only prepares you for board certification but also fulfills essential continuing education requirements, making it a practical and meaningful investment in your career.
Our course is designed for busy clinicians who want to strengthen their skills, expand their expertise, and confidently manage the complexities of older patients. Whether or not you’re pursuing certification, you’ll gain tools and insights that directly enhance your practice.
Enroll today in our Geriatric Medicine Board Review Course. Build expertise, earn CME, and be ready to meet the needs of a rapidly growing older adult population.
American Physician
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