CWRU nursing school researchers bring attention to older patients’ needs
Studies and resources help providers—and patients—focus on what matters most
As the U.S. population continues to age, healthcare providers face a growing challenge: balancing the treatment of diseases with patients’ priorities for how they want to live their lives. Two Case Western Reserve researchers say the solution begins with a question too often overlooked:
What matters most to you?
The answers may surprise providers at first—but they can change how care is delivered.
For some adults, the priority isn’t lowering blood pressure, improving lab results or managing symptoms. It’s attending a daughter’s wedding or a grandson’s baseball game.
Those responses aren’t unusual, according to a study based on patient surveys and co-authored by CWRU nursing researchers Mary Dolansky and Nicholas Schiltz. Nearly half of almost 390,000 older adults surveyed through care screenings at CVS MinuteClinics said social activities and inclusion—not immediate health concerns—mattered most to them.
“No one has done a study like this in this large of a population,” said Schiltz, PhD (GRS ’13, epidemiology and biostatistics), an assistant professor at Frances Payne Bolton School of Nursing. “It was surprising to see only about 20% of patients say their immediate health needs mattered most, and there was not much variation across age, sex or race groups.”
Published in JAMA Network Open, the survey was part of a national Age-Friendly Health Systems initiative, supported by the John A. Hartford Foundation, which encourages providers to begin conversations with patients about their goals—not just their diagnoses. While the study was conducted last year, more recent work to expand the project continues.
And now with a recent $2.57 million grant from the foundation, the researchers will bring their age-friendly expertise and guidance into primary-care practices.
“If our work helps cultivate a mindset that recognizes older adults’ need for care aligned with what matters most to them, that is a tremendous success,” said Dolansky, PhD, RN (GRS ’01 nursing), who holds the Sarah C. Hirsh Endowed Professorship at the nursing school.
To help patients advocate for themselves or loved ones, Dolansky and Schiltz have created a tip sheet focusing on the “4Ms”: what matters, medication, mind and mobility. It encourages patients to speak up about what matters most, reminds them they have a right to the healthcare they want and emphasizes being active participants in decisions about their care.
“If someone says, ‘I really want to be able to go to my daughter’s wedding,’ then any changes to medications or mobility aids can be thought of with those goals in mind,” Schiltz said.
With the new grant, the CWRU team will work with primary care providers around the country to embed the 4Ms into their work and train interdisciplinary care teams. A key aim is to help ensure healthcare starts with a simple question—and that every older adult feels empowered to answer it.
Illustration by Petra Sitaru
