Older adults value social connection over their own health

Across nearly 388,000 walk-in clinic visits, older Americans ranked social activities and inclusiveness above their own health.

The findings come from a team at Case Western Reserve University working with a national network of retail clinics.

What older adults value

The work was led by Nicholas K. Schiltz, an assistant professor at Case Western Reserve University’s Frances Payne Bolton School of Nursing (CWR). His group examined responses from patients ages 65 and older at walk in sites across 35 states.

In this study, clinicians asked each patient a short question, what matters most to you. Nearly half chose social activities and inclusiveness, with health, independence, and family togetherness trailing.

Responses were recorded in electronic health records, digital charts used to document care and decisions. That approach supported consistent capture across hundreds of locations.

Selections for social activities rose across 2021 through early 2024, while health and family togetherness declined. The statistical significance, a measure showing results are unlikely due to chance, was strong across years.

Why social connection matters

The CDC outlines health risks tied to social isolation, including higher chances of heart disease, dementia, and earlier death. Older adults face triggers like bereavement, limited mobility, and reduced community ties.

“I would have thought health would have been a little bit higher since this is an acute-care setting,” said Schiltz. His surprise mirrors a broader shift in how people define a life worth living.

How care can improve

Many systems now use the 4Ms, a four element framework that guides older adult care. The four areas are: What Matters, Medication, Mentation, and Mobility.

A non-randomized trial found that care aligned with patient priorities reduced treatment burden and cut unwanted care. Clinicians also stopped more medications and added fewer tests when they focused on what patients valued.

Peer-reviewed evidence shows how the 4Ms interact in daily practice to support safer decisions. When What Matters points to staying active with friends, the plan might favor balance training and simpler drug regimens.

“This is important work that is a part of The John A. Hartford Foundation Age-Friendly Health Systems movement across the country to ensure all older adults receive evidence-based care,” said Professor Mary Dolansky of the Frances Payne Bolton School of Nursing.

Limitations of the study

The analysis used predefined response categories that may not capture every nuance of personal goals. The low rate of other responses suggests fit, yet some aims may straddle more than one bucket.

This was a cross-sectional study, a snapshot of data rather than a test over time. It cannot prove why preferences shifted or whether clinic type influenced responses.

Turning social connection into care

Knowing that social connection often comes first should change the care conversation. Clinicians can start with what matters and then protect balance, brain health, and safe prescribing to support it.

A plan geared toward community engagement can include fall risk checks and simpler medication schedules. It can also flag transportation gaps that quietly block participation.

Social connection and aging

U.S. projections show that by 2030, one in five Americans will be of retirement age. That demographic turn will amplify the need to organize care around purpose and participation.

Health systems that reliably ask what matters can design visits that protect independence and connection. The same question can guide family discussions and community programs outside the exam room.

How clinics can respond now

Start every visit by documenting a patient’s single top priority for the coming months. Use that focus to cut out low-value tasks and zero in on the few actions that will make the biggest difference.

When the priority is staying active with others, coach on strength, balance, and mood while simplifying medications that raise fall risk. When it is family time, tailor pain control to safe function and set realistic goals.

Equity and consistency

Priorities were remarkably similar across sex, race, and ethnicity in the dataset. That consistency suggests the starting point for good care is universal and simple.

Asking the same question at each visit will catch changes after illness, grief, or new diagnoses. It also builds trust by showing that the team listens and adapts.

The bigger message

Older adults do not set aside their lives when they walk into a clinic. They bring goals that extend well beyond lab values and symptom scores.

Good care lines up with those goals, then builds out the safer steps to get there. The result is care that people are more willing to follow and more likely to benefit from.

The study is published in the journal JAMA Network Open.

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