Assessing What Matters Most in Older Adults With Multicomplexity

Abstract

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.

A Qualitative Study of “What Matters” to Older Adults in the Emergency Department

“…The extant literature lacks relevant feasible modalities to address the priorities of older adults seeking emergency care. Many, including the “What Matters” structured tool and the “Serious Illness Conversation Guide, 37 have been developed and assessed in non-ED settings, thereby limiting their translatability to patients seeking acute care. In our study, the average patient interview was three minutes and ranged from 1–8 minutes, suggesting a reasonable time to completion and feasibility of clinicians incorporating the “What Matters” questions within the time constraints of today’s ED clinical practice.…”

“I worry about this patient EVERY day”: Geriatrics Clinicians’ Challenges in Caring for Unrepresented Older Adults

“…Even in situations where a health care agent cannot be identified, characterizing the individual's values relative to health care decisions while they are able to communicate these values is essential (Naik et al, 2016;Whitlatch, 2008) particularly in the case of dementia (Dassel et al, 2018;Geshell et al, 2019;Orsulic-Jeras et al, 2020;Supiano et al, 2019). The elucidation of patient values to the extent possible is consistent with identifying what matters most to patients, an important component of the 4Ms framework of geriatric care outlined in the Age-Friendly Health Systems movement (Fulmer et al, 2018;Moye et al, 2021), and should inform subsequent care decisions made by guardians for unrepresented patients. It may be useful to engage other members of the interprofessional team-for example, geriatrics care managers, social workers, or nurses-in advance care planning conversations, or at minimum refer patients to self-directed Advance care planning (ACP) resources (Amundson, 2008;Dassel et al, 2019;Gaster et al, 2017;Institute for Health Care Improvement, 2021;Sudore et al, 2014).…”

Optimizing Medications with the Geriatrics 5Ms: An Age-Friendly Approach

“…With Multicomplexity, insufficient finances to purchase medications, caregiver burden, or residing in a care facility may affect how medications are accessed, and what we prescribe potentially affects prognosis and frailty. Most importantly, when we ask the patient What Matters to them, we learn which treatments they are willing to tolerate and which they find burdensome; a communication tool such as Patient Priorities Care may help clarify their preferences and goals [18,19]. Additionally, prescribing mis-aligned with What Matters, such as inadequate pain control, can impede patients from doing what they enjoy and reaching their goals.…”

“…Research is emerging on how application of the Age-Friendly approach can influence patient care and show a promising benefit [20]. While evidence is emerging about the implementation of the 4Ms framework as a set, evidence for interventions within each M domain has been shown to Consider in depth assessment of goals using PaƟent Priorities Care tool, for example [18], [19] Image icons licensed to Dr. Andrea Schwartz from thenounproject.com. AbbreviaƟons: CBTi = CogniƟve Behavioral Therapy for Insomnia, OT = OccupaƟonal Therapy, PT = Physical Therapy.…”