It’s a blessing to be an older adult.”
Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN

For decades, advocates have called for communities, neighborhoods, and organizations like hospitals to become more “age-friendly.” Although the idea of an age-friendly society has been promoted both locally and internationally, adoption remains more aspirational than an organized practice.

In this week’s episode of This Is Getting Old, Dr. Terry Fulmer and Amy Berman walk us through an overview of what it means to have created an Age-Friendly Ecosystem.

Part One of ‘The Age-friendly Ecosystems’.

The John A. Hartford Foundation has been working with the Age-Friendly Foundation to convene leaders of these age-friendly movements. The goal is to help make the “age-friendly” moniker clear to all stakeholders in terms of what it means.

At the George Washington University’s Center for Aging, Health and Humanities, we have adapted the Age-Friendly Ecosystem to include Arts & Creativity.’

What Exactly Is an Age-friendly Ecosystem? 

An Age-Friendly Ecosystem refers to the collective of all efforts to adapt society to meet older adults’ needs. In simpler terms, Age-Friendly Ecosystems are the comprehensive, collectively built, and ever-expanding platform whose goal is to improve older adults’ quality of life through enhanced, collective impact.

Moreover, understanding the Age-Friendly Ecosystem draws on the social-ecological model that acknowledges the connections and interplay between older adults and their environments or contexts.

Proponents of the Age-friendly Ecosystem Movement:

The Age-Friendly Ecosystem is a movement to create age-friendly cities and communities started by the World Health Organization and carried forward by AARP (American Association of Retired Persons).

The John A. Hartford Foundation (JAHF) launched the Age-Friendly Health Systems movement with the Institute for Healthcare Improvement in 2017 to ensure the specific needs of older adults are met in health care. JAHF in 2018 then collaborated with the Trust for America’s Health (TFAH) to involve public health agencies to expand the implementation of the age-friendly guidelines to the public health domain, acknowledging that these programs, notwithstanding their goals, have remained constrained and siloed. Many other organizations are advancing initiatives to make universities and businesses age-friendly.

The Goals and Objectives of Age-Friendly Ecosystems:

The goal of Age-Friendly Ecosystems has been to help make the “age-friendly” moniker clear to all stakeholders regarding what it means and how it should be adapted.

The work is leading to developing a common language and shared metrics so that anyone can recognize it and know what should be expected when we say “age-friendly.”

By working together across silos, different age-friendly initiatives can maximize their collective impact.

An Age-Friendly Ecosystem refers to the collective efforts to adapt society to meet older adults’ needs worldwide.
– Terry Fulmer, PhD, RN, FAAN

Guiding Principles and Frameworks of Age-friendly Ecosystems:

Each of the age-friendly initiatives has its guiding principles and frameworks. A big part of our effort is to help us understand those frameworks and what the shared characteristics are across them.

The 4Ms Framework:

An Age-Friendly Health System reliably delivers evidence-based care that reduces harm and focuses on What Matters most to older adults and their families. It is based on what we call the 4Ms Framework – essential elements of care that need to be addressed for all older adults – What Matters, Medication, Mentation, and Mobility.

The 5Cs Framework:

The Age-Friendly Public Health Systems movement uses the 5Cs Framework:

  • Connecting and convening sectors and professions
  • Coordinating existing supports and services
  • Collecting data to assess community health status
  • Conducting, communicating, and disseminating research findings and best practices
  • Complementing and supplementing existing supports and services

These frameworks are specific to the sector, clinical or public health in these examples but undergirding all of these frameworks are commonalities that lead us to the characteristics of an Age-Friendly Ecosystem.

Part Two of ‘The Age-friendly Ecosystems’.

Characteristics of Age-friendly Ecosystems:

The convenings of leaders in the Age-Friendly Ecosystem, in addition to surveys of older adults, literature reviews, and expert interviews, have led to an understanding that several characteristics represent an age-friendly ecosystem. Understanding these characteristics helps us get to common language and metrics.  A forthcoming journal article will explain these characteristics and their definitions.

Age-Friendly Ecosystems: Current Standing in Terms of the Needed Common Language and Metrics 

Since the fall of 2020, the Age-Friendly Foundation has been drafting a measurement taxonomy. They did that by identifying six outcome measurement domains that represent dimensions of age-friendliness.

The domains are groups of similar outcomes, while the outcomes are explanatory concepts that can be inferred from measured or observed data.

The Foundation is also looking at indicators or ways of measuring desired outcomes.

They’ve looked at all the different frameworks outcomes and indicators – the Age-Friendly Health Systems, the Age-Friendly Public Health, WHO Age-Friendly Cities, AARP Livable Communities, Age-Friendly CAFÉ (Employers), and Age-Friendly Universities Principles— to supplement work in the health and public health frameworks.

Furthermore, the Foundation reviewed CDCs Healthy People 2030 indicators for Healthy Aging and Access to Care and the Association of State and Territorial Health Officials Policy Statement on Aging to expand and quantify outcomes related to health well-being.

They’ve started with specific outcomes, such as Mobility, Walkability, Access to Jobs, and Labor Force Engagement. For each outcome, they identified indicators (or measures) recommended by IHI, CDC, WHO, and so on.

In some cases, they’ve added indicators where there were gaps based on a review of the literature. All of these are still in draft stages, and there is more to come.

Everyone has a role to play in eradicating ageism.
– Terry Fulmer, PhD, RN, FAAN.

How To Do Your Part In Building The Age-friendly Ecosystem?

Everyone is encouraged to implement age-friendly programs, which will also  help us counter ageism and help all of us age with dignity and respect. In whatever sector you are in, reach out across to other partners.

Start by checking out the blog on You can find linked additional resources for age-friendly initiatives such as the Age-friendly Health Systems, Age-friendly Universities, and many more.

You can also join in the existing age-friendly initiatives, for example, the Age-Friendly Health Systems movement, by going to Or visit Trust for America’s Health or our website for more information on how to join the Age-Friendly Public Health Systems initiative, which has a new website:

We’ve seen great success in this with public health working with aging services, working with health systems. This all connects to a crucial issue and call to action – everyone has a role in eradicating ageism, which is discrimination based on age. This means calling it out when you see and hear it. It requires you to make sure you aren’t contributing to ageist perceptions of older adults.says Dr. Terry Fulmer, a nationally and internationally recognized leading expert in geriatrics. 

Older adults rightfully want and deserve dignity and respect. – Amy Berman, RN, LHD, FAAN

About Terry Fulmer, PhD, RN, FAAN:

Terry Fulmer, PhD, RN, FAAN, is the President of The John A. Hartford Foundation in New York City, a foundation dedicated to improving older adults’ care. She serves as the chief strategist for the Foundation, and her vision for better care of older adults is catalyzing the Age-Friendly Health Systems social movement. Dr. Fulmer is an elected member of the National Academy of Medicine and recently served on the independent Coronavirus Commission for Safety and Quality in Nursing Homes to advise the Centers for Medicare and Medicaid Services. She completed a Brookdale National Fellowship, and she is the first nurse to have served on the American Geriatrics Society board. The first nurse to have served as President of the Gerontological Society of America, which awarded her the 2019 Donald P. Kent Award for exemplifying the highest standards for professional leadership in the field of aging.

About Amy Berman, RN, LHD, FAAN:

Amy Berman is a Senior Program Officer with The John A. Hartford Foundation. She works on the Foundation’s development and dissemination of innovative, cost-effective care models that improve health outcomes for older adults. Among these efforts, Dr. Berman is responsible for the Foundation’s work to advance Age-Friendly Health Systems, led by the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association.  She also leads many of the Foundation’s efforts focused on Serious Illness and End of Life, including efforts to support Diane Meier’s palliative care and the Center to Advance Palliative Care.



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About Melissa:

Melissa Batchelor, PhD, RN, FNP, FGSA, FAAN. I am a nurse, nurse practitioner, nurse educator and nurse researcher with over 25 years of experience in the aging and long-term care healthcare space. You can visit my website at to learn more about me, how you can work with me directly,
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