What Matters Most?

One of the four M's in the age-friendly health care system model is

"What Matters"

It is the first M in the 4Ms framework because it anchors all the other M's: Medication, Mentation, and Mobility.

Everyone knows what matters to them.

So, things are going well, we don't feel that making a long term care plan is vitally important or something we need to talk about with family members, caregivers, or loved ones at this point. Tomorrow maybe. But that just might be a day too late. An emergency, a hospitalization, or your health condition declines suddenly.

Uh-oh! Now you are scrambling without knowing what matters most, and making presumptive decisions about your care.

Knowing what matters most can be one of the greatest gifts you give your loved ones.When serious illness, injury, or aging changes arise, families are often suddenly asked to make difficult medical decisions. In those moments, it can feel overwhelming to not know what your loved one would truly want.

When values, wishes, and priorities have already been talked about, loved ones are not left only guessing, or simply following whatever medical recommendation is presented at the moment. Instead, they are better able to speak with confidence and advocate for care that reflects the person’s own goals, beliefs, and definition of quality of life.

Medical teams can explain treatment options, but only the individual — and those who know them well — can answer questions such as:

• “What kind of life would feel meaningful to me?”

• “What abilities matter most to me?”

• “What trade-offs would I or would I not want to make?”

• “Would I want every possible treatment, or would comfort and quality of life matter more?”

These conversations help families move from uncertainty toward clarity. They can reduce guilt, conflict, and second-guessing during emotionally difficult times, while supporting more patient-centered care and shared decision-making.

On our POLST and our Advance Health Care Directive, we check little boxes indicating our choices about DNR (Do Not Resuscitate), DNI (Do Not Intubate).

But, there is one option left out and that is an important option to talk about: DNH (Do Not HOSPITALIZE).

Because, maybe, you are sick of going to the hospital, and don't want to go back anymore because each time you come out, you don't get much better and your wishes, what Matters most, is that you stay at home in the most comfortable setting. This choice should be an option too.

All too often, the default mode and switch is "treatment", "procedures", "hospitalization".

Take time to have the sometimes more challenging discussions with your loved one way before the time comes. This is very important to think about doing if your loved one has been diagnosed with dementia. Before it's too late, understand their goals, their values, what Matters, so you can advocate when they can no longer make those decisions.