Novel approach helps older patients thrive

An age-friendly approach borrowed from geriatric practice can improve rheumatology care for patients of all ages, not just chronologically older individuals.

The approach is the 5Ms, focusing on mind, mobility, medications, multi-complexity, and what matters most to the older adult patient. Developed to help guide gerontology care, the concept is spreading to other specialties focused on chronic diseases and patients who are living longer, receiving more medications as comorbidities mount, and have distinct priorities about what matters most in their lives.

“The 5Ms are a framework, a mnemonic that can help organize the complexity of rheumatology care,” said Daniel K. White, PT, ScD, MSc, Associate Professor of Physical Therapy, University of Delaware. “The 5Ms are a way to help comprehensively manage the patient in ways that are addressing multiple symptoms, challenges, and needs that change over time.”

Dr. White will discuss ways the 5Ms can help clinicians better understand and manage the complex challenges of rheumatologic diseases during Inspire Older Patients to Thrive! The 5M’s of Aging on Sunday, November 13, 10:30–11:30 a.m. ET, in Room 122 of the Pennsylvania Convention Center. Meeting participants have the option to attend the session in person or to view it on demand.

“By incorporating the 5Ms, we can take better care of the whole patient,” added Una Makris, MD, MSc, Associate Professor of Rheumatic Diseases, The University of Texas Southwestern Medical Center. “The medical and psychosocial complexity that comes with caring for some of our older patients can be overlooked and underassessed. This can impact some of the outcomes we routinely monitor. The majority of our patients, hopefully, will be growing older in our care. Patient priorities and needs can be quite different over time. The 5Ms can help us assess some of these key concepts that are so integral to keeping our older patients thriving.”

Changing demographics are also bringing more older adults into rheumatology clinics as first-time patients. Osteoarthritis, rheumatoid arthritis, polymyalgia rheumatica, giant cell arteritis, and other common rheumatologic diseases can occur at any age but are more likely to present in older adults.

“We base our practices on guidelines that come mostly from younger to middle-aged adults and clinical trial data,” said Jiha Lee, MD, MHS, Assistant Professor of Rheumatology, University of Michigan College of Medicine. “We don’t have a lot of data that is generated from older adults. Geriatrics and many other specialties are increasingly recognizing that older adults are biologically different. Inflammaging and immunosenescence can alter their susceptibilities and responses to treatment. Time and changing psychosocial factors can alter their goals of care. The 5Ms are a way of contextualizing these factors in all of our patients, whatever their chronological age.”

It’s easy to dismiss the 5Ms and other age-appropriate models as agist, noted Elena Myasoedova, MD, PhD, Associate Professor of Internal Medicine and Epidemiology, Mayo Clinic College of Medicine and Science. The reality is that patients do change over time. Rheumatologic disease can accelerate many of those changes, leaving younger rheumatology patients looking and acting much older than their years.

“Patients with rheumatic diseases, specifically rheumatoid arthritis, age prematurely,” Dr. Myasoedova said. “Our younger patients, on the biological level and on the level of their comorbidities, are much older than their chronological age. Compared to the same age group in the general population, our rheumatoid arthritis patients have more comorbidities, more functional disabilities, more mental impairments. It’s not your actual age that matters, it’s your biological, functional and mental age. That’s where the 5Ms help tailor care to the individual.”