Skip to main content

Improving Age-Friendly Care

The week of October 17, 2022 saw three separate manuscripts with University of Utah co-authors published in the same week, all of which align with equity, diversity, and inclusion themes. “Exploring the Intersection of Structural Racism and Ageism in Healthcare,” published in the Journal of the American Geriatrics Society, serves as a foundational paper to help guide the American Geriatrics Society’s efforts to build a more just health care system. “Academic Health Centers and the Quintuple Aim of Health care,” published in Academic Medicine, is among the first papers to advance the idea that equity should be its own distinct aim in health care and builds upon a JAMA paper by Nundy, Cooper and Mate earlier in 2022. Finally, “Age-friendly care in the Veterans Health Administration: past, present, and future,” published in the Journal of the American Geriatrics Society, points out that policy makers and non-VHA health care systems should look to VHA innovations as models for advancing age-friendly care models.

Since age-friendly care also opposes inequities such as ageism, future papers are planned by University of Utah faculty to demonstrate how University of Utah Health is developing and implementing anti-ageism efforts as a key component of its Age-Friendly Health Systems Committed to Care Excellence designation.

    The American Geriatrics Society (AGS) has consistently advocated for a healthcare system that meets the needs of older adults, including addressing impacts of ageism in healthcare. The intersection of structural racism and ageism compounds the disadvantage experienced by historically marginalized communities. Structural racism and ageism have long been ingrained in all aspects of US society, including healthcare. This intersection exacerbates disparities in social determinants of health, including poor access to healthcare and poor outcomes. These deeply rooted societal injustices have been brought into the forefront of the collective public consciousness at different points throughout history. The COVID-19 pandemic laid bare and exacerbated existing inequities inflicted on historically marginalized communities. Ageist rhetoric and policies during the COVID-19 pandemic further marginalized older adults. While the detrimental impact of structural racism on health has been well documented in the literature, generative research on the intersection of structural racism and ageism is limited. The AGS is working to identify and dismantle the healthcare structures that create and perpetuate these combined injustices and, in so doing, create a more just US healthcare system. This paper is intended to provide an overview of important frameworks and to guide future efforts to both identify and eliminate bias within healthcare delivery systems and health professions training with a particular focus on the intersection of structural racism and ageism.



    • Timothy W. Farrell MD, AGSF
    • William W. Hung MD, MPH
    • Kathleen T. Unroe MD, MHA, AGSF
    • Teneille R. Brown JD
    • Christian D. Furman
    • Jane Jih MD, MPH, MAS
    • Reena Karani MD, MHPE
    • Paul Mulhausen MD, MHS
    • Anna María Nápoles PhD, MPH
    • Joseph O. Nnodim MD, PhD, FACP, AGSF
    • Gina Upchurch RPh, MPH
    • Chanel F. Whittaker PharmD, BCGP, FASCP
    • Anna Kim LMSW
    • Nancy E. Lundebjerg MPA
    • Ramona L. Rhodes MD, MPH, MSCS, AGSF


    Farrell, T.W., Hung, W.W., Unroe, K.T., Brown, T.R., Furman, C.D., Jih, J., Karani, R., Mulhausen, P., Nápoles, A.M., Nnodim, J.O., Upchurch, G., Whittaker, C.F., Kim, A., Lundebjerg, N.E. and Rhodes, R.L. (2022), Exploring the Intersection of Structural Racism and Ageism in Healthcare. J Am Geriatr Soc. Accepted Author Manuscript.

    The Quintuple Aim of health care adds health equity to the existing Quadruple Aim of improving the individual experience of care for patients, improving the health of populations, reducing the per capita cost of care, and improving the experience of health care professionals. health equity has previously been subsumed within the other 4 aims. Elevating health equity to the status of a distinct aim is necessary to address persistent health inequities that disproportionately affect underrepresented and minoritized groups. Academic health centers (AHCs) bear a unique responsibility to advance health equity due to the societal importance of their 4 missions: patient care, education, research, and community collaboration. Interprofessional education and practice provide natural connection points that enable AHCs to prepare both health professions students and practicing health care professionals to address all 5 aims. AHCs are well positioned to assess health outcomes related to health equity, develop a health care workforce that is representative of their communities, develop innovative research questions regarding health equity, and engage and invest in the communities they serve.



    • Timothy W. Farrell MD, AGSF
    • Annette G. Greer, PhD, MSN, RN
    • Scott Bennie PT, DSc, MBA
    • Heather Hageman MBA
    • Andrea Pfeifle EdD, PT

    Farrell, Timothy W. MD1; Greer, Annette G. PhD, MSN, RN2; Bennie, Scott PT, DSc, MBA3; Hageman, Heather MBA4; Pfeifle, Andrea EdD, PT5. Academic Health Centers and the Quintuple Aim of Health care. Academic Medicine: October 18, 2022 doi: 10.1097/ACM.0000000000005031

    The Veterans Health Administration (VHA) has long recognized the need for age-friendly care. VHA leadership anticipated the impact of aging World War II veterans on VA healthcare systems and in 1975 developed Geriatric Research, Education, and Clinical Centers (GRECCs) to meet this need. GRECCs catalyzed a series of innovations in geriatric models of care that span the continuum of care, most of which endure. These innovative care models also contributed to the evidence base supporting the present-day Age-Friendly Health Systems movement, with which VHA is inherently aligned. As both a provider of and payor for care, VHA is strongly incentivized to promote coordination across the continuum of care, with resultant cost savings. VHA is also a major contributor to developing the workforce that is essential for the provision of age-friendly care. As VHA continues to develop and refine innovative geriatric models of care, policymakers and non-VHA health care systems should look to VHA programs as exemplars for the development and implementation of age-friendly care.



    • Timothy W. Farrell MD, AGSF
    • Tiffany A. Volden MD
    • Jorie M. Butler PhD
    • G. Paul Eleazer MD
    • Randall W. Rupper MD, MPH
    • Katharina V. Echt PhD
    • Marianne Shaughnessy PhD, AGPCNP-BC, GS-C
    • Mark A. Supiano MD, AGSF

    Farrell, TW, Volden, TA, Butler, JM, et al. Age-friendly care in the Veterans Health Administration: past, present, and future. J Am Geriatr Soc. 2022; 1- 8. doi:10.1111/jgs.18070

    Timothy W. Farrell, MD, AGSF

    Oct 27, 2022 8:35 AM