Delivering an Age-Friendly Health System – A Blueprint to Transform Health and Healthcare for Older Adults published
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From: Department of Health
- Published on: 2 December 2025
- Last updated on: 2 December 2025
The Minister of State for Older People and Housing, Kieran O’Donnell, TD, has today marked the publication by the Health Service Executive (HSE) and the Department of Health Age-Friendly Health System (AFHS), a blueprint intended to transform health and healthcare for older adults in Ireland.
Becoming an AFHS means using the evidence-based 4Ms Framework: ‘What Matters’, ‘Medications’, ‘Mind’ and ‘Mobility’ – to provide efficient, appropriate and high-quality care for every older adult.
The AFHS blueprint sets out an ambitious plan to become a country where the entire health system is designed and delivered through an age-friendly lens, to support longer lives by integrated, person-centred, high-quality care.
The framework has been developed on a collaborative basis across the Department of Health, HSE, and frontline staff, integrating clinical expertise with the preferences and will of older adults.
Minister O’Donnell, said:
“Our ageing population is growing and people in Ireland are living longer than ever before. This brings with it a shared responsibility to ensure that longer lives are also healthier, more independent, and more fulfilling.
“The Blueprint for an ‘Age-Friendly Health System’ represents an important step in progressing this. It sets out a clear and ambitious mission for Ireland to become a country where the entire health system is designed and delivered through an age-friendly lens that enhances the lives and wellbeing of all older adults.
“It means seeing older people as active partners in their own care: individuals whose knowledge, experience, and preferences must shape the decisions made about them.
“Recognising the change in Ireland’s older population, I am pleased to have secured significant additional funding for older persons services in 2026 of €215 million, representing a rise of over 7% on 2025. Budget 2026 is the largest ever for older persons services with over €3 billion allocated to maintain and further enhance these services.”
Siobhán McArdle, Assistant Secretary, Social Care, Mental Health, Drugs Policy and Unscheduled Care Division at the Department of Health, said:
"The rise in life expectancy is a tremendous societal achievement, but it requires us to fundamentally adapt how we deliver care. The Department of Health views the Age-Friendly Health System Blueprint as a necessary step in ensuring older adults receive the bespoke, integrated, person-centred care they require as our population ages. By committing to the consistent use of the four Ms (What Matters, Medication, Mind, and Mobility), we are looking to embed a framework that simplifies complex care and supports people to remain healthy, active, and autonomous throughout their lives.
"This blueprint is perfectly aligned with the core objectives of Sláintecare delivering timely, high-quality, integrated care at the lowest level of complexity, supporting older people to age well in place. The Department of Health is actively pursuing this age-friendly future through significant initiatives such as the Enhanced Community Care Programme, the development of a National Dementia Registry to guide services, and our crucial cross-Government collaborations including the Healthy Age Friendly Homes Programme. This multi-sectoral approach, working alongside local government and the community sector, is vital to providing a truly rounded model of care for our older population."
Dr Colm Henry, Chief Clinical Officer, HSE, said:
"To ensure older adults receive safe, effective and dignified care, we must move beyond obsolete and outdated models and implement care systems which proactively support what matters to people as they age. This Blueprint sets out a clear and evidence-based path forward. Using the internationally recognised 4Ms Framework - What Matters, Medications, Mind and Mobility - we will support every older person to receive high-quality, coordinated care across all settings, from home and community services to hospital and rehabilitation.
"In contrast to systems of care which are not configured to the needs of older people, Age-Friendly Health Systems have consistently been shown to improve outcomes, reduce harm and enhance the experience for older adults and staff. By adopting this approach, we are committing to a healthcare system where older adults can live well, maintain independence and experience care that truly reflects what matters to them.
“This is a significant step for Ireland, made possible through strong collaboration with older adults, the Department of Health, HSE and our partners across the continuum of care and services for older adults. Together, we can deliver a health system, a system that truly meets the needs of the people who are using it - today and into the future."
The AFHS is aiming to better simplify the complexities of care for older adults and organises care to focus on their wellness and strengths. The 4Ms framework does not replace existing models of care or care pathways. The intention is to incorporate the 4Ms framework into existing care across all settings, rather than adding another layer of complexity
By consistently integrating the ‘4Ms’ framework, significant positive outcomes are anticipated, including:
- Improved patient outcomes and experiences of care
- A reduction in Emergency Department (ED) attendance and readmissions
- Reduced Length of Stay (LoS) in hospitals
- Decreases in polypharmacy and adverse drug events
- More cost-effective, efficient, and integrated care pathways
Work has already commenced to evaluate these principles across the health system. In 2021, Cork University Hospital (CUH) became the first site in Europe to receive formal recognition as an Age-Friendly Health System by the Institute for Healthcare Improvement (IHI).
Building on this foundation, the HSE South-West 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.
Notes
The 4Ms Framework
The ‘4Ms’ Framework simplifies the complexities of care for older adults and organises care to focus on their wellness and strengths. The intention is to incorporate the ‘4Ms’ into existing care across all settings, rather than adding another layer of complexity.
The 4Ms are:
What Matters: We must understand what matters most to each older adult, ensuring care aligns with their will and preferences, and aligning care decisions with the older adult’s priorities and goals, not just their diseases.
Medication: We must prescribe medication thoughtfully and safely, choosing medications that benefit 'What Matters', Mind, and Mobility. The objective is to eliminate unnecessary, ineffective, and duplicate medications.
Mind: We must support a healthy mind and emotional wellbeing by the prevention, early recognition, and treatment of delirium, dementia, and depression.
Mobility: We must support older adults to live, thrive, and do ‘What Matters’ most to them, ensuring early, frequent, and safe mobility to maintain function
Actions and Progress
Work has already commenced to evaluate these principles across the health system. In 2021, Cork University Hospital (CUH) became the first site in Europe to receive formal recognition as an Age-Friendly Health System by the Institute for Healthcare Improvement (IHI).
Building on this foundation, the HSE South-West 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.
Delivering Timely and Integrated Care
The AFHS approach builds on the core objective of Sláintecare to deliver timely, high-quality, person-centred, integrated care at the lowest level of complexity, supporting older people to age well in place. Older adults are recognised as having unique and specific care needs, requiring bespoke assessments and treatments.
Older adults are the highest per capita users of healthcare services. They attend their GP an average of 8 times a year, and 90% of those attending Emergency Departments are triaged as needing immediate and urgent care. Furthermore, older adults utilize 57% of acute hospital bed days and use most of the 26.7 million hours of home support provided annually.
Expected Impacts and Cultural Change
By consistently integrating the 4Ms, significant positive outcomes are anticipated:
- Improved patient outcomes and experiences of care.
- A reduction in Emergency Department (ED) attendance and readmissions.
- Reduced Length of Stay (LoS) in hospitals.
- Decreases in polypharmacy and adverse drug events.
- More cost-effective, efficient, and integrated care pathways.
The launch event included presentations from international experts, including Mr Pedro Delgado, Vice President of the Institute for Healthcare Improvement (IHI), and Regius Professor Rose-Anne Kenny and Professor Cathal McCrory from TILDA, TCD, whose Wave 6 Report provides the evidence base for adopting the 4Ms nationally.
The blueprint aligns with the Sláintecare reform of the health and social care system.