# “What Matters” to Community-Dwelling Older Adults With Dementia and Their Family Caregivers: A Qualitative Pilot Study

## TL;DR

This study explores what matters most to older adults with dementia and their caregivers during annual wellness visits and how these priorities align with a healthcare framework.

## Contribution

This is the first study to map health goals and worries of dementia patients and caregivers to the IHI-4Ms framework in the context of annual wellness visits.

## Key findings

- Three overarching goal themes were identified: physical/mental health maintenance, cognitive maintenance, and independence.
- Six worry themes included cognitive decline, behavioral changes, and loss of independence due to health decline.
- Goals and worries were mapped to the IHI-4Ms framework, suggesting potential for addressing them during annual wellness visits.

## Abstract

Drawing on the Institute of Healthcare Improvement (IHI)’s 4Ms framework of an Age-Friendly Health System in primary care to incorporate “What Matters,” mentation, mobility, and medication, this qualitative/interview pilot study listened to “What Matters” most to community-dwelling Medicare beneficiaries with dementia and family caregivers in the context of Annual Wellness Visit (AWV). We then mapped identified “What Matters” themes (health goals and worries) to IHI-4Ms. Twenty-four caregivers and two patients participated in a one-time phone/Zoom interview. We observed three overarching goal themes (physical/mental health maintenance, cognitive maintenance, and independence) and six overarching worry themes (cognitive decline, behavioral changes, health decline leading to loss of independence, mobility issues, dehydration, and caregivers’ financial responsibility). The identified goals and worries were mapped to at least one of IHI-4Ms components, indicating the potential for addressing these through AWVs. Our study is the first to understand “What Matters” to Medicare beneficiaries with MCI/ADRD in the context of AWVs and to map the identified health goals and worries to IHI-4Ms. The valuable lessons learned in this pilot study underscore the potential need for practical health policy considerations to support dementia-friendly AWVs so that “What Matters” to patients with MCI/ADRD and caregivers can be heard/discussed during AWVs.