Asking Older Adults What Matters to Them: A Framework that Can Lead to Increased Healthy Years

Frank had been healthy for most of his life, and he had already lived longer than both of his parents. Then things took a turn, and one health issue led to the next. Not only was his health deteriorating, but he would also complain that all he did with his time was go to doctors’ appointments. Frank is my dad; he passed in 2025. And unfortunately, his experience was not unique for older adults.

While people are living longer on average, the number of healthy years is not increasing at the same rate, and countless older adults are contending with a range of health conditions. Furthermore, an array of chronic conditions can mean multiple health care providers, which can complicate matters.

For people in situations similar to my dad’s, there is good news: A person-centered movement is responding to these needs and complexities.

After one doctor’s appointment that had frustrated my dad, I asked him, “What matters most to you?”

He looked at me quizzically. “What do you mean?” he replied. “No one has ever asked me that before.”

And so, we talked about that question, and the questions underlying it, along with his answers. What did he love doing? (Travel with my mom, lunches with his friends, time with his grandchildren.) What were the hurdles that prevented him from doing what he cared about? (Health complications limited his mobility and restricted his diet, preventing him from engaging in his favorite activities, which was tough because he was such a social person.)  And what goals and values did he have that motivated him each day? (He cared about family and his faith.)

More and more, health care teams are asking these types of questions. They are recognizing the importance of taking the time to understand what matters most to older adults  so that, together, they can develop care plans that truly meet each person’s individual needs.

That approach is at the heart of an initiative of the John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) to create what they call the Age-Friendly Health Systems movement. The patient-focused Age-Friendly Health Systems movement, which aims to provide high-quality care to older adults, is based on a framework, known as the 4Ms—What Matters, Medication, Mentation, and Mobility—that promotes shared decision making between providers and older adults. There are more than 5,600 clinical care settings nationwide that are working to integrate evidence-based interventions that incorporate the 4Ms framework into their care of older adults.

Shifting the conversation

As Dr. Mary Tinetti of the Yale School of Medicine has put it, “We’re moving the conversation from treating each disease in isolation to what matters most to the individual given their overall health and life.” Tinetti, a geriatrician focused on helping older people with multiple health conditions receive well-rounded care, says that once that conversation shifts toward the individual occurs, the person becomes an active participant in their health journey.

I learned firsthand through my dad how the 4Ms framework helped him think about the conversations he wanted to have with his doctors. Reflecting on those 4M-centered questions, all offshoots of the overarching question of what mattered most to him, provided purpose in his lifestyle decision making, including committing to regular exercise and sticking to his new diet. The movement to encourage these conversations between caregivers and older adults, and, subsequently, between doctors and the people they treat, is helping more individuals feel like partners rather than passive patients in their health care journeys.

Forthcoming blogs will highlight examples of how shared decision making is contributing to healthy longevity. We’ll also provide specifics on how it has improved health quality as individuals age.