Background and Objectives Abilities and activities that are often simultaneously valued may not be simultaneously achievable for older adults with multi-complexity. Because of this, the Geriatrics 5M’s framework prioritizes care on “what matters most.” This study aimed to evaluate and refine the What Matters Most-Structured Tool (WMM-ST). Research Design and Methods 105 older adults with an average of 4 chronic conditions completed the WMM-ST along with open-ended questions from the Serious Illness Conversation Guide. Participants also provided demographic and social information, completed cognitive screening with the T-MoCA-Short and frailty screening with the Frail Scale. Quantitative and qualitative analyses aimed to (1) describe values; (2) evaluate the association of patient characteristics with values, and; (3) assess validity via the tool’s (a) acceptability (b) educational bias and (c) content accuracy. Results Older adults varied in what matters most. Ratings demonstrated modest associations with social support, religiosity, cognition, and frailty, but not with age or education. The WMM-ST was rated as understandable (86%) and applicable to their current situation (61%) independent of education. Qualitative analyses supported the content validity of WMM-ST, while revealing additional content. Discussion and Implications It is possible to assess what matters most to older adults with multi-complexity using a structured tool. Such tools may be useful in making an abstract process clearer but require further validation in diverse samples.

Nontraditional women students, defined as older than 24 years, parents, or veterans, compose a fast-growing higher education population. Many face identity-related challenges when interacting with advisors. From 2 northeastern U.S. women's colleges, 42 nontraditional women students participated in phenomenological interviews focused on their advising experiences, including the way advisors engaged with their identities. We classified 6 themes, 3 positive (guidance, identity recognition, advocacy) and 3 negative (indifference, identity marginalization, gatekeeping), that underscored the centrality of advisor engagement with identity for advisee-defined experiences. Advisors encouraged nontraditional women when recognizing intersectional identities as assets but also marginalized students through stereotyping or communicating low expectations. We highlight implications for future research and practice in this domain.

Nurses play an essential role in managing mental health conditions, such as posttraumatic stress disorder (PTSD), especially in rural areas where access to mental health care is limited. Posttraumatic stress disorder may emerge at the end of life and complicate health care and is a particular concern for aging Vietnam veterans. We describe the development of 3 videos that illustrate how to recognize PTSD, respond to trauma disclosures, and manage PTSD in cognitive impairment during an in-home hospice nurse visit. Through problem identification and needs assessment, we identified 6 goals and 28 specific content objectives presented through cinematic action with flashbacks or voice-over narration with graphics. Videos were evaluated through a survey (N = 155) and analysis of “chat” responses (N = 186) to targeted questions during a webinar presentation to clinicians (N = 345). Approximately 75% rated videos as “very much” relevant to needs, having helped learn something new, and realistic. Analysis of chat responses showed videos conveyed most content objectives (92%). In addition, participants stated videos were helpful in demonstrating nursing skills of listening, responding, and displaying empathy, as well as showing case presentations involving cognitive impairment and the patient experience. Participants expressed a desire for longer videos/more information including a wider range of PTSD presentations and comorbidities.