PhD Dissertation Defense: Jennifer de la Cruz
bis
Georgia, Georgia
Dissertation Title: Age-Friendly Interventions for Community-Dwelling Adults With Dementia: A Scoping Review Student Concentration: Health Services Research Dissertation Chair: Dr. Terri Pigott Dissertation Abstract: The Age-Friendly Health Systems 4Ms framework: What Matters, Medication, Mentation, and Mobility, was developed to guide age-friendly care and has been widely applied in institutional healthcare settings. However, the core domains represented by the 4Ms are also central to the care of community-dwelling older adults with dementia, whose needs often extend across medical care, functional support, caregiver involvement, and community-based services. Applying the 4Ms as an organizing framework to community-based interventions may therefore help identify the extent to which existing approaches address these interrelated needs. This scoping review examined interventions for community-dwelling older adults with dementia and evaluated how those interventions aligned with the 4Ms framework. The review followed the methodological framework of Arksey and O’Malley, refinements proposed by Levac and colleagues, and PRISMA-ScR guidance. Literature published from 2017 onward was identified through database, dissertation, grey-literature, and reference searches. The final review included 128 publications representing 112 unique studies. Most interventions addressed more than one of the 4Ms. Mentation was represented in 107 studies (95.5%), What Matters in 80 (71.4%), Mobility in 67 (59.8%), and Medication in 16 (14.3%). Fifteen studies addressed one M, 46 addressed two Ms, 43 addressed three Ms, and only eight addressed all four Ms. The most common combination was What Matters, Mentation, and Mobility. More than half of the interventions were delivered primarily in the home. The eight interventions addressing all four Ms shared several characteristics, including multicomponent design, caregiver involvement, individualized care, repeated contact, and frequent use of home-based or interdisciplinary approaches. These findings demonstrate that many existing community-based dementia interventions already incorporate elements of age-friendly care, even when they were not developed explicitly using the 4Ms framework. However, comprehensive alignment with all four Ms remains uncommon. The 4Ms may provide a useful framework for organizing and evaluating community-based dementia interventions across settings, but additional research is needed to determine whether interventions addressing more of the 4Ms, or particular combinations of the 4Ms, are associated with better patient and caregiver outcomes. Future studies should also examine the effectiveness, feasibility, scalability, and sustainability of more comprehensive approaches to dementia care.