When Jill Shutes began her nursing career more than three decades ago, hospitals were still learning how best to care for older adults. The prevailing focus was on treating illness and injury, not necessarily on preserving independence or quality of life for older patients during hospitalization.
Now a geriatric nurse practitioner and the gerontological clinical coordinator at Jupiter Medical Center, Shutes has spent her career helping shift that mindset. Her path into elder care began with a personal appreciation for older adults—specifically, her grandparents, who lived independently into their 90s. She was drawn to their stories and to the practical wisdom they carried. “As a young nurse in my 20s, I wanted to learn what to do and what not to do, and older patients have those stories,” she recalls.
Today, that interest is a guiding force not just for her department, but for the entire hospital. In August 2025, JMC became recognized as an "Age-Friendly Health System—Committed to Care Excellence," a distinction awarded through a national initiative led by the Institute for Healthcare Improvement and The John A. Hartford Foundation. It marks the hospital’s commitment to a care model designed specifically for patients 65 and older—one that promotes better outcomes, fewer complications, and greater dignity during and after hospitalization.
Caring for a Rapidly Aging Population
At the heart of the age-friendly approach is a framework known as the 4Ms: what matters, medication, mentation, and mobility. Together, these principles reshape the way care is delivered—from the first conversation with a patient to the moment they leave the hospital, and often, well beyond.
The process begins with asking older patients not simply what symptoms they’re experiencing, but what matters most to them. Do they want to regain strength in time for an upcoming family event? Is their goal to manage pain rather than pursue aggressive treatment? Those answers should guide every step of the care plan, whether it’s selecting a course of treatment or determining discharge plans. The goal is to avoid paternalism and instead center each decision on the patient’s values.
That same personalized approach extends to medications. As people age, certain prescriptions can become less appropriate—or downright harmful. Drugs that might help control a chronic condition could also contribute to confusion or sedation. That’s why age-friendly hospitals make it standard practice to review medication lists with an eye toward side effects that specifically affect older patients. Just as important, they educate patients and families on how to advocate for safer, more age-appropriate alternatives.
Cognitive health is another essential focus. A recent Centers for Disease Control and Prevention (CDC) report found that only about 4 percent of adults 65 and older report have had a dementia diagnosis—despite evidence that as many as 13 percent of those over 85 have been diagnosed. This gap indicates many more older adults are living with undiagnosed cognitive conditions.
Age-friendly systems implement regular screenings for delirium, often twice a day, and train staff to identify signs like confusion, disorientation, or sudden changes in behavior. Even small environmental adjustments—opening blinds to let in natural light or encouraging hydration—can help prevent hospital-acquired cognitive decline. When a patient screens positive, Shutes is often consulted for care planning and alternate interventions that may be of assistance.
Then there’s mobility, which often determines how well an older patient recovers after a hospital stay. Even just a few days in bed can lead to rapid muscle loss, prolonged recovery times, and increased fall risk. In an age-friendly system, the emphasis is on encouraging movement early and often. Patients are supported in getting out of bed multiple times a day, even if it’s just for a short walk down the hallway or time spent sitting upright. The difference can be profound: less time in rehab, fewer complications, and a better chance of being discharged and returning home rather than to a facility.
These priorities are increasingly critical as the U.S. population ages at historic rates. According to the U.S. Census Bureau, more than 73 million Americans will be over the age of 65 by 2030—outnumbering children for the first time in the country’s history. By 2040, older adults are projected to make up more than 20 percent of the population.
At the same time, older adults account for a disproportionate share of hospitalizations, medication use, and chronic disease diagnoses. More than 80 percent of adults over 65 have at least one chronic condition, and nearly 30 percent live with some form of cognitive impairment.
The CDC reports that falls are the leading cause of injury-related death among older adults—and even brief hospital stays can dramatically increase the risk.
Hospitals that don’t evolve their practices risk seeing higher readmission rates, longer recovery times, and avoidable complications—all of which take a toll on patients, families, and caregivers alike.
At JMC, the broader vision for elder-focused care extends well beyond the inpatient setting. The hospital is also home to the Johnny and Terry Gray Alzheimer’s and Dementia Caregiver Support Program, a community-facing initiative that addresses one of the most urgent and emotional aspects of aging: memory loss and cognitive decline.
The program is designed to support patients and the family members who care for them, offering a range of services that goes beyond traditional clinical care. Caregivers receive education, emotional support, and access to local resources—all tailored to the evolving needs of individuals living with Alzheimer’s disease or other neurocognitive disorders.
This kind of support is not a luxury. An estimated 6.7 million Americans currently live with Alzheimer’s disease, and that number could nearly double to around 14 million by 2060. In Florida, the challenge is especially acute: the state ranks second in the nation for total number of Alzheimer’s patients, with more than 580,000 individuals currently affected.
Hospital-wide Standard of Care
These changes don’t happen in a vacuum. At JMC, participation in the Age-Friendly initiative built on years of progress through NICHE (Nurses Improving Care for Healthsystem Elders), an international program that trains nursing staff in best practices for elder care. The hospital participated systemwide in the education program through the generous support of the Glenn W. and Cornelia T. Bailey Geriatric Nursing Education Program.
But the age-friendly model extends well beyond nursing. Care teams across departments are engaged in this effort—from hospitalists and therapists to pharmacists and case managers—ensuring that each patient receives consistent support.
For families, choosing a hospital for an aging loved one often comes with difficult decisions. But there are signs to look for that indicate a health-care system is truly prioritizing elder care. Is the hospital actively participating in the Age-Friendly Health Systems initiative? Does the care team ask early on about the patient’s personal goals? Are medications reviewed for their appropriateness in older adults? And is there a clear emphasis on preventing cognitive decline and encouraging mobility during recovery?
At JMC, those questions are built into the standard of care. Each element—what matters, medication, mentation, and mobility—is part of the daily rhythm. Teams meet regularly to review patient progress and adjust care plans as needed. Case managers work closely with families to ensure that patients have what they need at discharge, whether it’s home health support, assistive devices, or follow-up appointments. As an Age-Friendly Health System, JMC not only follows the principles of elder-focused care but models them as standard practice across the entire organization.
“I see all of these things as opportunities for us to just simply do a better job,” Shutes says.
For patients and their families, that commitment means something tangible: a system that sees older adults not as a burden or a challenge, but as individuals with lives still being lived—stories still being told—and care worth getting right.