A Research and Implementation Roadmap from the VA's National State-of-the-Art Conference on Age-Friendly Care for Veterans.

Andrea Wershof Schwartz Amitai Avnon Sawicki Tehilah Meged-Book Shivani K. Jindal Amelia E. Schlak Camilla B. Pimentel K. Boockvar Dawn M. Bravata S. C. Sullivan Heather Davila Katherine S. Hall S. N. Hastings Kayla Lalande Luci K. Leykum Whitney L. Mills Cathy C. Schubert M. Shaughnessy J. Stevens-Lapsley Inés Valencia-Mendoza Kimberly A. Wozneak James L. Rudolph Robert E. Burke

Oct 2026 · NEJM catalyst innovations in care delivery · Vol 7 11, pp. CAT260327 · 0 citations · 28 references

Medicine

Abstract

The U.S. Department of Veterans Affairs (VA) Veterans Health Administration (VHA) is among the largest integrated health systems in the United States to systematically adopt the Age-Friendly Health Systems (AFHS) framework developed by the Institute for Healthcare Improvement and the John A. Hartford Foundation. This national implementation, spanning hospitals, ambulatory clinics, community living centers (with VA skilled nursing facilities), home-based primary care teams, and more, has positioned the VA as a national leader in operationalizing the 4Ms framework of Mobility, Mentation, Medications, and What Matters, across multiple care settings, with meaningful early clinical impacts. However, dissemination of the AFHS framework within the VA has been uneven, and robust data are lacking about the implementation and outcomes of the 4Ms framework. To better understand this implementation gap and research needs, the VA Offices of Research and Development and Geriatrics and Extended Care convened a national state-of-the-art (SOTA) conference in 2025, bringing together invited experts from around the country to identify what is known and unknown about the implementation, sustainment, measurement, research, and scaling of the AFHS framework in general, and specifically within the VA health system. The purpose of the VA Age-Friendly SOTA conference was to explore this gap and to provide guidance to the field for areas of future work, acknowledging that meaningful scale and sustainment will require additional research, infrastructure, and deeper understanding of implementation in real-world environments. This article describes the resulting VA Age-Friendly research and implementation agenda, a roadmap derived from what the VA has learned from implementing the 4Ms at scale, depicting practical lessons learned and suggesting next steps for Age-Friendly systems transformation to improve the care of older adults.

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