A Nurse-Led, Age-Friendly Educational Program to Reduce Stroke Risk and Promote Healthy Behaviors among Older Adults: A Randomized Controlled Trial

Background: Stroke remains a major cause of disability and mortality globally, particularly among older adults in low- and middle-income countries. Integrating the 4Ms framework (What Matters, Medication, Mentation, and Mobility) into nursing-led preventive interventions offers a holistic, person-centered model for promoting healthy aging and mitigating stroke risk. Aim: This study evaluated the effectiveness of a nurse-led, age-friendly educational program, grounded in the 4Ms framework, in reducing stroke risk and enhancing health-promoting behaviors among older adults. Methods: A randomized controlled trial was conducted with 170 community-dwelling adults (≥60 years) attending outpatient clinics in Egypt. Participants were randomized to either a 4Ms-based educational intervention (two structured sessions and materials) or a control group receiving routine care. Outcomes were measured using the Revised Framingham Stroke Risk Profile, the Health-Promoting Lifestyle Profile II, and a stroke prevention practices questionnaire. Results: Post-intervention, the intervention group demonstrated a significant reduction in 10-year stroke risk scores (p<.001) and significant improvements across all health-promoting behavior domains, especially physical activity, nutrition, and stress management (all p<.001). The percentage of participants with good stroke-prevention practices increased from 7.1% to 55.3%. Stroke risk was also inversely correlated with domains like health responsibility and stress management. Conclusions: The nurse-led, 4Ms-based educational program is highly effective in reducing stroke risk and fostering healthy behaviors among older adults in a low-resource setting. Embedding the 4Ms framework within preventive nursing care provides a sustainable and holistic approach to healthy aging.