A nurse-led, 4Ms-guided educational model was effective in reducing stroke risk and enhancing health-promoting behaviors in older adults, suggesting that integrating such age-friendly, nurse-led interventions into national policies could significantly strengthen preventive care and promote healthy aging.
Key Findings
Results
The nurse-led educational intervention based on the 4Ms framework produced a significant reduction in Revised Framingham Stroke Risk Profile (R-FSRP) scores in the intervention group compared to controls.
Reduction in R-FSRP scores was statistically significant at p < .001 with a medium-to-large effect size (Cohen's d = 0.78)
The randomized controlled trial included 170 older adults randomized to intervention or control groups
Per-protocol analysis included 161 participants who completed follow-up (intervention n = 81; control n = 80)
Statistical analyses included independent and paired t-tests, chi-square tests, and calculation of effect sizes
Results
The proportion of participants with 'good' stroke-prevention practices increased substantially in the intervention group from pre- to post-intervention.
The proportion with 'good' stroke-prevention practices increased from 7.1% to 55.3% (p < .001)
This represents an approximately 48 percentage point absolute increase
The control group was used for comparison via chi-square tests
Results
The intervention produced considerable improvements across all Health-Promoting Lifestyle Profile II (HPLP-II) domains, with the largest effects seen in nutrition and physical activity.
Nutrition showed the largest effect size (Cohen's d = 2.10)
Physical activity showed the second largest effect size (Cohen's d = 1.60)
Improvements were noted across all HPLP-II domains, not just nutrition and physical activity
HPLP-II was one of two primary outcome measures alongside the R-FSRP
Methods
The intervention consisted of two nurse-led educational sessions based on the 4Ms framework (What Matters, Medication, Mentation, and Mobility) supplemented by three months of telephone reinforcement.
The 4Ms framework is described as a person-centered approach to stroke prevention within the Age-Friendly Health Systems (AFHS) model
Telephone reinforcement continued for three months post-session
The study was conducted in a context described as a low- and middle-income country setting
The study noted limited prior evidence from low- and middle-income countries for this model
Background
Stroke is identified as a primary cause of disability and death globally, particularly among older adults, motivating the study of preventive nurse-led interventions.
The study highlights limited evidence from low- and middle-income countries regarding age-friendly stroke prevention models
The Age-Friendly Health Systems 4Ms framework is described as offering 'a practical, person-centered approach to stroke prevention'
Assessing this model's impact in 'resource-constrained contexts is crucial' according to the authors
What This Means
This research suggests that a structured educational program led by nurses and based on the '4Ms' framework (What Matters, Medication, Mentation, and Mobility) can meaningfully reduce stroke risk and improve healthy behaviors in older adults. The study enrolled 170 older adults in a randomized controlled trial, with one group receiving two educational sessions plus three months of follow-up phone calls, and a comparison group receiving no intervention. After the program, participants in the intervention group showed significant reductions in their measured stroke risk scores and large improvements in health-promoting behaviors, particularly in nutrition and physical activity. The share of participants with 'good' stroke-prevention practices jumped from about 7% to over 55%.
This research matters because stroke is one of the leading causes of death and disability worldwide, and older adults are especially vulnerable. The study was conducted in a resource-limited setting, which is important because most existing research on such programs comes from wealthier countries. The findings suggest that relatively simple, nurse-led educational interventions — requiring only two sessions and telephone follow-up — can produce substantial improvements in stroke risk reduction even where resources are constrained.
The authors suggest that integrating this kind of age-friendly, nurse-led education into national health policies could strengthen preventive care for older adults at a broad scale. This research points toward nurse-led programs as a practical and potentially scalable tool for stroke prevention in aging populations, especially in countries where specialist medical resources may be limited.
Fouad R, Ahmed-Shoulkamy T. (2026). A nurse-led age-friendly education model to prevent stroke in older adults: Implications for policy and practice.. Applied nursing research : ANR. https://doi.org/10.1016/j.apnr.2026.152086