What Matters to You?

From curbside grocery pick-up to binge watching our favorite television shows, most of us are used to having our desires or needs met promptly. Integrating this concept into healthcare practice means creating a more personalized environment for patients, especially the rapidly increasing 65 years and older population.  

This simple, yet ingenious “4Ms” framework, is called Age-Friendly Health Systems and begins with the care team asking the question “what matters to you?”– rather than “what is the matter with you?” What Matters means knowing and aligning care with the older adult’s specific health outcome goals and care preferences that should be respected across all settings of care.

The age-friendly journey in Nashua began in the St. Joseph Hospital’s Acute Rehabilitation Center and Ambulatory Primary Care Clinics where the majority of the patient population is over the age of 65.

“The thing that really encouraged me about this journey is knowing that we are already doing much of this,” said Acute Rehabilitation Center Clinical Nurse Manager Glory Wabe, MSN, RN, CRRN. “Now, it’s just a matter of aligning our care plans to be sure that we focus on all aspects of this program.”

This journey to become an Age-Friendly Health System started in December 2019. St. Joseph Hospital is one of the first two hospitals in New Hampshire which attained the much- coveted recognition by the Institute for Healthcare Improvement. Along with the Acute Rehabilitation Center, are the Ambulatory Primary and Specialty Services and Family Medicine Clinics achieving Age-Friendly Health System-Committed to Care Excellence recognition by IHI.

To learn more, talk to your provider about Age-Friendly Health Care

Older adults are the fastest growing population in the country. According to the U.S. Census Bureau, those age 65+ are expected to double in number in the next 25 years, reaching 84 million people by 2050.

But there’s a catch. Each older person is as different as one sunset is from the next — beautiful, complex and one-of-a-kind. Older adults actually become more different from one another as they age, say geriatric experts. This is especially true when factoring in cultural differences, values and preferences combined with their life experiences and chronic conditions.

“A lot of times in health care we know what the best clinical plan would be. What we don’t know is what’s in the mind of our patient,” said Wabe.

“Most patients treated at the Rehab Center want to be strong and live their lives independently no matter what their diagnosis is,” said Wabe. “They have goals such as wanting to attend their granddaughter’s wedding or joining their friends on a cruise”. We focus on helping patients achieve the things that are important to them.”

A closer look at Age-Friendly

In Age-Friendly Health Systems, the four Ms — what matters, medication, mentation and mobility — guide discussions and decisions. The intent is to keep older patients active, engaged, healthier and happier over their lifetime, while also respecting their individual preferences.

• What Matters: Learn and honor patient preferences to guide care including patient-specific health goals, care preferences, cultural differences, priorities and end-of-life care.

• Medication: If medications are needed, choose those that do not interfere with patient preferences, mental capacity or mobility.

• Mentation: Identify and attend to any changes in mental awareness, mood, dementia or delirium across care settings.

• Mobility: Ensure older adults maintain ability to move safely every day in order to keep strong and functioning so they can do “What Matters”.

When a 65+ year old patient is admitted to the Rehab Center, goals are documented in their care plan and on patient’s whiteboard. This might mean that instead of giving sleeping or anxiety medications right away when a patient complains of inability to sleep at night, staff talks about the patient’s favorite subject like the grandchild or pet in the picture. Or reduce anxiety and “sundowning” symptoms by staying with the patient and talk about things that matter to him/her. Sometimes just the physical presence of a staff and holding the patient’s hand assures them that they are not alone. We can do things like: play relaxing music or do foot massage, spray lavender scent on pillowcases to help induce sleep. The patient can then wake up in the morning free of the adverse effects of the “unfriendly” sleeping medications. This improves mental awareness and mobility and often helps a patient recover faster.

“It brings me satisfaction knowing we are taking care of our older patients and making them more satisfied with the care they get from us. Our plan is to introduce this method of care to all departments in our hospital,” said Wabe. “At St. Joseph Hospital, our mission is to provide healing and care for the whole person. Age-Friendly Health Care puts the focus on our patients’ needs and wishes. By asking questions and listening to what really matters, we empower our patients to live lives that they define as fulfilling.”