From What Matters to What Works: Older Adults' Priorities within the 4Ms and a Community-Led 4R Model in Urban India — a qualitative descriptive study
Year: 2026
Type: preprint
Abstract: Background Support for India's older population remains fragmented, and urban care is largely hospital-centered. This study examined what older adults identify as priorities within the 4Ms framework (What Matters, Medication, Mentation and Mobility) and how these could inform community responses. Methods Thirty community residents aged 70 years and above were sampled for maximum variation in an urban sector of North India. Home interviews structured around the 4Ms were supplemented by ethnographic observation and conducted in Hindi/Punjabi/English. Two authors independently coded transcripts by directed content analysis and inductive thematic analysis of residual material. Reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist; frequencies indicate within-cohort salience, not prevalence. Results Mean age was 80.3 years (range 70–94); 57% were women; 73% lived in joint families. Within the 4Ms framework: autonomy and dignity were the dominant values (60%); polypharmacy was identified in 30.0%, with inadequate symptom control in 20%; cognitive impairment was identified in 16.7% and depression/low mood in 23.3%; independent mobility was preserved in 53.3%, with falls reported in 26.7% and 83.3% engaging in no structured physical activity. The 4Ms framework effectively identified needs but did not address operational care delivery. Four recurring unmet needs—emergency responsiveness, outreach to homebound elders, resource navigation, and structured rehabilitation—formed the basis of the proposed 4R framework. Conclusions The 4Ms surfaced clinical priorities alongside operational and relational needs, and the 4R framework offers a citizen-led response pathway when elders cannot reach formal services. Prospective multi-site validation with standardized outcomes is required. Trial registration: Not applicable.
Source: Research Square
Language: English
Subfield: Life-span and Life-course Studies
Field: Social Sciences
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7225390405