Assessing “What Matters Most” among Hospitalized Older Adults using a Geriatric Consult Service

Background

The 4M’s framework was created to help standardize and improve care for the geriatric population who often face poor outcomes. What matters is an essential part of the 4M’s framework that has been shown to have the lowest rate of assessment in the inpatient setting. Our study assesses the frequency, documentation, and content of what matters assessments by a geriatric consult service.

Methods

Our study includes patients who were 65 or older at time of admission who received a geriatric consult service at Memorial Hermann Hospital from January 1, 2025, to May 31, 2025. We conducted a retrospective chart review and descriptive analysis to assess the frequency of “What Matters” assessments. We also conducted an inductive thematic analysis on the content of “What Matters” documentation.

Results

Out of 110 total patients seen by the geriatric consult service, 62.7% had what matters assessed. There were no statistically significant differences in demographics, medical history, or hospital course for patients with and without what matters assessed. The four themes we found for “What Matters” content in order of most prevalent to least is: Maintaining Independence and Function, Social Connections, Maintaining Health and Well Being, and Spirituality.

Conclusions

We did not find an increased rate of assessment of “What Matters” by a geriatric consult service. Although documentation identified patient values, no entries translated those values into actionable care plans or included realistic, measurable goals. We developed a conceptual model connecting the different themes identified in our qualitative analysis that can be used to guide what matters assessments. In addition to more thorough “What Matters” assessments, use of structured, validated tools, such as Patient Priorities Care (PPC) and Goal Attainment Scaling (GAS), is necessary to ensure that these assessments are translated into practical, actionable goals.