Supporting Better Ageing in Irish Nursing Homes – The 4Ms Framework

Together, these principles help ensure care is coordinated around the individual needs, goals, and wellbeing of each resident. 

 What Matters: This principle encourages nursing home staff to understand what is most important to residents — their routines, preferences, values, relationships, and personal goals. Whether supporting meaningful activities, respecting daily choices, or involving families in care planning, person-centred conversations remain at the heart of quality care. 

Medication: Older adults are often prescribed multiple medications, which can increase the risk of side effects, falls, or confusion. The 4Ms framework promotes regular medication reviews and safe prescribing and de-prescribing practices. The aim is to ensure medications support residents’ overall wellbeing and independence. 

Mind: Mind (also known as Mentation) focuses on cognitive and emotional wellbeing, and its impact on quality of life. Nursing homes are increasingly supporting residents through meaningful activities, social engagement, dementia-friendly environments, mental health awareness, and early recognition of cognitive changes. For many residents, small moments of connection — music, reminiscence, conversation, or familiar routines — can have a powerful impact on wellbeing. 

Mobility: Maintaining mobility is essential for preserving independence and quality of life. Encouraging safe daily movement, promoting physical activity, and supporting falls prevention can help residents maintain confidence, strength, and social participation.  

 The principles of the 4Ms align closely with national priorities around healthy ageing, dignity, resident rights, and person-centred care in residential settings. Importantly, the 4Ms are not additional tasks — they are a practical way of organising everyday care around the whole person. 

 Growing Momentum in Ireland 

Ireland’s healthcare system is placing increasing emphasis on age-friendly and integrated care. Since 2021, Cork University Hospital has been the first site in Europe to receive formal recognition as an Age-Friendly Health System. HSE Southwest is advancing a proof of concept to establish Ireland’s first Age-Friendly Health region, with early progress adopting the 4Ms Framework across acute, rehabilitation, residential, and community services. 

Caru was invited to be part of a research group in Cork in early 2026, led out by Dr Hannah O’ Brien – ICPOP, Marymount University Hospital and Hospice, to develop a ‘Age-Friendly Health Systems 4Ms Transfer Document’ that will be used between Acute settings and Nursing Homes. This will help with the transition of care between settings and assure it aligns with the 4Ms framework. A pilot of the new transfer document is expected later this year. 

The principles underpinning Caru are repeatedly reflected in 4M’s practice: early conversations, interdisciplinary collaboration, recognition of the role of all staff (particularly healthcare assistants), and a focus on what matters most to the resident.