Using the Geriatric 5Ms During Hospitalist Rounds

The Geriatric 5Ms framework gives hospitalists a practical way to organise care around five priorities: Mind, Mobility, Medications, Multi-complexity and What Matters Most. At Hospital Medicine 2017 (HM17), held at Mandalay Bay in Las Vegas from 1–4 May 2017, these principles fitted naturally with discussions about safer transitions, evidence-based inpatient medicine and care for people living with several chronic conditions. Learn more about Wild Symbols Expanding.

For Australian clinicians, the framework is especially useful because older patients often move between emergency departments, acute medical units, residential aged-care facilities (RACFs), community services and family homes. A short, disciplined review can make a routine ward round more person-centred without turning it into a lengthy geriatric assessment.

Why the Five Ms Belong on Every Ward Round

The first lesson is that the 5Ms are a prompt for clinical prioritisation rather than a separate checklist added after the “real” medical work. Mind includes delirium, dementia, mood and cognition. Mobility covers baseline function, falls risk and the ability to transfer safely. Medications asks whether each drug is still necessary, safe and aligned with the patient’s goals.

Multi-complexity recognises that frailty, multimorbidity, social circumstances and treatment burden interact. What Matters Most places the person’s values, preferred living arrangements and acceptable outcomes at the centre. A useful conference programme can provide broad educational context, but the framework becomes valuable when it changes what the team does before lunch.

On an Australian ward, this may mean identifying whether a patient from a Melbourne RACF can return with the same level of support, or whether a person transferred from a rural hospital needs an altered discharge plan. Medicare funding, state-based health services and local community capacity all affect what is achievable, so the final “M” must include a realistic discussion of place, transport and carers.

Turning Each M Into a Bedside Question

Mind should be assessed through observation as well as conversation. Ask whether the patient is at their cognitive baseline, check hearing aids and glasses, review sleep disruption, and look for new inattention or fluctuating alertness. A patient who is quiet after surgery may have hypoactive delirium rather than simple fatigue. Documentation should distinguish known dementia from an acute change.

Mobility is more informative when it describes function. “Mobilising” can conceal whether someone walked independently at home, used a four-wheel walker, needed one assistant or was already largely bedbound. On rounds, the hospitalist can ask physiotherapy and nursing staff about transfers, toileting and walking distance, then link the findings to falls prevention and discharge readiness.

Medication review should include prescribing, administration and deprescribing. Consider anticholinergic burden, sedatives, opioids, insulin, anticoagulants and drugs affected by renal function. In Australia, checking the admission history against the electronic medical record, My Health Record where available, pharmacy records and the RACF medication chart can reveal discrepancies. The review is strongest when the team explains which medicines are temporary and which are intended for long-term use.

A Round That Makes Priorities Visible

A conventional ward round often starts with diagnosis, observations, pathology and imaging. Those details remain essential, yet the order can push function and goals into the final minutes. The 5Ms offer a parallel structure that keeps clinical instability and geriatric risks visible together.

A two-minute bedside sequence can work well: “How is the patient thinking today? What can they physically do? Which medicines need reconsideration? What complicates the plan? What outcome matters most to them?” The answers should lead to named actions, not just descriptive notes.

This approach also supports multidisciplinary rounds. Nurses may identify overnight confusion, pharmacists may find a duplicate or high-risk medicine, physiotherapists may report a marked functional decline, and social workers may know that a family cannot provide weekend care. The hospitalist’s role is to combine these observations into one coherent plan.

Applying the Framework to Common Australian Cases

Consider an 86-year-old woman admitted in Brisbane with pneumonia, heart failure and recurrent falls. She normally walks to the local shops with a frame, manages simple meals and values returning to her apartment. The 5Ms would prompt a delirium screen, medication review for sedatives and hypotension, supervised mobilisation, hydration planning and a discussion about whether short-term support at home is preferable to an automatic RACF transfer.

For a man from a Sydney residential facility admitted with venous thromboembolism, the team must balance thrombosis treatment against renal impairment, falls, bleeding history and his ability to manage follow-up. HM17’s discussion of VTE prophylaxis takeaways is a useful reminder that risk assessment should be individualised rather than reduced to a default prescription.

Multi-complexity also includes legal and social context. Guardianship and consent arrangements differ across Australian states and territories, and a substitute decision-maker does not simply replace the patient’s voice. Clinicians should establish decision-making capacity for the specific choice, involve the appropriate representative when required, and record the patient’s known preferences. The National Safety and Quality Health Service Comprehensive Care Standard supports this integrated approach to risks such as delirium, falls, pressure injuries and medication harm.

Making What Matters Most Operational

“What matters” should result in a care decision. It might be remaining alert enough to speak with grandchildren, returning to a partner, avoiding another hospital admission, attending a cultural or religious event, or maintaining the ability to shower independently. Asking about these priorities early can change the intensity and timing of investigations, rehabilitation and discharge planning.

A brief script is often enough: “What are you hoping to be able to do when you leave hospital?” followed by “What would make this admission feel like a poor outcome?” These questions are particularly important when a patient has frailty, advanced disease or repeated admissions. Families can contribute useful information, but staff should avoid allowing the loudest relative to define the patient’s goals without checking the patient’s own views.

The framework can also help with escalation decisions. If a patient would not want invasive treatment that is unlikely to restore a valued function, that preference should be discussed before deterioration occurs. Clear documentation in the progress note, handover and discharge summary prevents the plan from being lost during weekend cover or transfer between metropolitan and regional services.

Habits That Help the Framework Last

The 5Ms work best when attached to ordinary ward systems rather than dependent on one enthusiastic clinician. A team might place the five prompts in the electronic rounding template, include baseline function in the admission history and require a medication indication beside each high-risk drug. Brief education at handover can help junior doctors and nurses use the same language.

Practical habits for Australian hospital teams include:

• Record baseline cognition, mobility, living arrangement and usual supports within the first day.
• Ask pharmacy, nursing and allied health staff to contribute one 5Ms finding during multidisciplinary rounds.
• Use mobility goals such as “walk 20 metres with a frame” instead of vague terms like “mobilise”.
• Reconcile medicines against RACF charts, community pharmacy information and available digital records.
• Document the patient’s preferred outcome and the agreed substitute decision-making process when relevant.

These actions are small enough for a busy general medical unit and flexible enough for hospitals in Adelaide, Perth, Canberra or regional communities. They also support safer transitions across ambulance services, acute hospitals, rehabilitation units, aged-care homes and general practice.

The lasting HM17 lesson is that geriatric care is not a specialist activity reserved for a separate consultation. A hospitalist can use the 5Ms during an ordinary bedside review to notice delirium earlier, protect function, reduce medication burden, understand complexity and honour personal goals. The framework does not replace sound diagnosis or urgent treatment; it makes those decisions more complete.

What readers should remember is simple: every older patient’s round should cover mind, movement, medicines, complexity and what matters most, because a medically successful admission is only truly successful when it also protects the person’s function, safety and priorities.