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OtherPractice

Optimizing geriatric care with the GERIATRIC 5Ms

Frank Molnar and Christopher C. Frank
Canadian Family Physician January 2019, 65 (1) 39;
Frank Molnar
Specialist in geriatric medicine practising in Ottawa, Ont.
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Christopher C. Frank
Family physician practising in Kingston, Ont.
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Clinical question

When can geriatric medicine and care of the elderly physicians best help me care for medically complex frail seniors?

Bottom line

In 2017, Canadian and US specialists in geriatric medicine officially launched the GERIATRIC 5Ms: mind, mobility, medications, multicomplexity, and matters most (Table 1).1 This aide-memoire represents a common-sense, practical, easy-to-remember repackaging and rebranding of the “geriatric giants” to better define those care issues that reflect the expertise of specialists in geriatric medicine and family physicians with care of the elderly training.

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Table 1.

The GERIATRIC 5Ms

Evidence

  • Comprehensive geriatric assessment has been shown to improve outcomes for frail seniors in acute care and rehabilitation settings, and models of care involving geriatricians in family medicine have shown positive outcomes and patient and provider satisfaction.2

  • Geriatric outreach teams performing home visits have been shown to decrease mortality rates in patients aged 65 to 80 and to reduce nursing home admission rates.3

  • Geriatric day hospital care was associated with reduced death, reduced institutionalization, greater independence, and higher levels of physical function.4

Approach

All of the clinical issues listed in the GERIATRIC 5Ms (Table 1)1 are managed daily by family physicians, but there might come a time when physicians with care of the elderly training or geriatric medicine specialists can help you care for your older patients. When reviewing a medically complex and frail senior, employ Table 11 and ask yourself, “Has the older patient now reached the point where he or she would benefit from a consultation and collaborative care with experts in seniors’ care, who might have access to specialized teams and resources that I do not?”

Implementation

The GERIATRIC 5Ms have attracted considerable attention in the United States5 and the United Kingdom.6 The GERIATRIC 5Ms are now used to guide care in an increasing number of sites in the United States, Canada, Australia, and New Zealand.

Join the movement. Consider the GERIATRIC 5Ms when planning care and when selecting patients for referral to care of the elderly or geriatric medicine physicians. Check if your specialists recognize the new “high five” visual presentation of the GERIATRIC 5Ms! (See the picture at http://canadiangeriatrics.ca/wp-content/uploads/2017/04/UPDATE-THE-PUBLIC-LAUNCH-OF-THE-GERIATRIC-5MS.pdf.)

Also, review the 5 Fs of frailty in this issue of Canadian Family Physician (page 74).7

Notes

Geriatric Gems are produced in association with the Canadian Geriatrics Society Journal of CME, a peer-reviewed journal published by the Canadian Geriatrics Society (www.geriatricsjournal.ca). The articles summarize evidence from review articles published in the Canadian Geriatrics Society Journal of CME and offer practical approaches for family physicians caring for elderly patients.

Footnotes

  • Competing interests

    None declared

  • Copyright© the College of Family Physicians of Canada

References

  1. 1.↵
    1. Molnar F,
    2. Huang A,
    3. Tinetti M
    . Update: the public launch of the geriatric 5Ms. Can Geriatr Soc J CME 2017 Apr 28. Available from: http://canadiangeriatrics.ca/wp-content/uploads/2017/04/UPDATE-THE-PUBLIC-LAUNCH-OF-THE-GERIATRIC-5MS.pdf. Accessed 2018 Dec 4.
  2. 2.↵
    1. Ellis G,
    2. Whitehead MA,
    3. O’Neill D,
    4. Langhorne P,
    5. Robinson D
    . Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev 2011;(7):CD006211.
  3. 3.↵
    1. Swain K,
    2. St John P
    . Multidimensional preventative home visit programs: helping patients to live better in place. Can Geriatr Soc J CME. Vol. 2.(8) 2018. Available from: https://canadiangeriatrics.ca/wp-content/uploads/2018/10/3_Phil-St.-John-Article-Formatted-final.pdf. Accessed 2018 Dec 4.
  4. 4.↵
    1. Peitsch L,
    2. van Ineveld C,
    3. Moran J,
    4. St John P
    . The geriatric day hospital: comprehensive, multi-disciplinary geriatric care for community-dwelling older adults. Can Geriatr Soc J CME. Vol. 6.(2) 2016. Available from: http://canadiangeriatrics.ca/wp-content/uploads/2017/02/The-Geriatric-Day-Hospital.pdf. Accessed 2018 Dec 4.
  5. 5.↵
    1. Tinetti M,
    2. Molnar F,
    3. Huang A
    . The geriatrics 5M’s. A new way of communicating what we do. J Am Geriatr Soc 2017;65(9):2115. Epub 2017 Jun 6.
    OpenUrl
  6. 6.↵
    1. Molnar F
    . The GERIATRIC 5Ms – the 5 simple words every geriatrician needs to know (the new mantra) [blog]. BGS Blog 2017 Oct 13. Available from: http://bit.ly/5MsBGS. Accessed 2018 Dec 5.
  7. 7.↵
    1. Freedman A,
    2. McDougall L
    . Frailty 5 Checklist. Teaching primary care of frail older adults. Can Fam Physician 2019;65:74-6. (Eng), e47–50 (Fr).
    OpenUrlFREE Full Text
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Canadian Family Physician: 65 (1)
Canadian Family Physician
Vol. 65, Issue 1
1 Jan 2019
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Optimizing geriatric care with the GERIATRIC 5Ms
Frank Molnar, Christopher C. Frank
Canadian Family Physician Jan 2019, 65 (1) 39;

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Frank Molnar, Christopher C. Frank
Canadian Family Physician Jan 2019, 65 (1) 39;
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