How Laboratories Can Help Transform Healthcare for Older Adults

As healthcare systems adapt to meet the needs of an aging population, laboratory testing will play a critical role in supporting older adults’ unique needs. For patients with advanced illnesses or limited life expectancy, frequent diagnostic tests might inadvertently add to discomfort without improving outcomes. But current testing algorithms often don’t take this demographic into account.  

The Age-Friendly Health Systems (AFHS) initiative was officially launched in 2019 by the John A. Hartford Foundation, the Institute for Healthcare Improvement, the American Hospital Association, and the Catholic Health Association. It was created to help healthcare teams deliver more personalized care to older adults by following a 4M framework: What Matters, Medication, Mentation, and Mobility. Among these, the “What Matters” pillar is especially relevant to laboratories, as it emphasizes understanding each patient’s personal health goals and care preferences when making decisions about testing.   

While AFHS provides a powerful roadmap, implementing its principles in laboratory medicine is still a work in progress. In a recent perspective published in Clinical Chemistry and Laboratory Medicine, Melody Boudreaux Nelson, DCLS, CC(NRCC), MS, MLS(ASCP)^CM, and Candice Coffey, MD, FAAFP, AGSF, tackle this problem head-on and collaborated to share their insights with Critical Values.   

Why ‘What Matters’ is central to laboratory medicine  

The “What Matters” pillar of the AFHS emphasizes understanding an older adult’s preferences, especially in cases of poorer prognoses or end-of-life care, and then ensuring those priorities guide all aspects of care, including laboratory diagnostics.   

“It involves all settings of care, like a hospital, skilled nursing facility, office visits, and can include end-of-life care,” explain Dr. Nelson, assistant clinical professor, Pathology and Laboratory Medicine , University of Kansas Medical Center, and Dr. Coffey, associate professor, Department of Internal Medicine, University of Kansas Medical Center. “But despite its importance, ‘What Matters’ remains the least developed of AFHS’s 4Ms.”  

This presents a challenge for laboratory professionals, since traditional testing algorithms frequently overlook older adults’ needs.  

“If we are truly working toward a value-based approach to healthcare, we can’t only define positive patient outcomes under treatment plans,” Drs. Nelson and Coffey say. “We must expand our thinking to how specific patients define positive outcomes for themselves in a state of shared decision making.”   

By integrating “What Matters” into diagnostic practices, laboratories’ testing strategies can better reflect older patients’ goals rather than defaulting to one-size-fits all protocols.   

Laboratories are facing systemic gaps in older patient care   

One of the biggest challenges that laboratory professionals face is the lack of clear testing guidelines and algorithms tailored to older patients with poorer prognoses or limited life expectancy. This can leave laboratories and clinicians defaulting to repetitive testing, even when the results may have little impact on care.   

“From a ‘What Matters’ approach, we should be establishing draw limits for high-acuity care environments at risk for iatrogenic anemia,” Drs. Nelson and Coffey say. “And then go a step further in working alongside intensive care providers to establish testing frequency criterion for routine labs and rule in/rule out algorithms in poor prognosis scenarios.”   

But the problem is more systemic than simply altering testing frequency. Medical education also hasn’t kept pace with the complexities of aging.   

“Medical students and laboratory students have a lack of education regarding prognostication, and age-friendliness in general,” Drs. Nelson and Coffey say. “Older adults have a higher prevalence of chronic disease and declining organ function, which can impact laboratory tests. Finding true normal for a reference range could prove challenging.”  

Laboratories can serve as partners in delivering more patient-focused care  

For laboratories to fully embrace the “What Matters” approach, they must be seen as active partners in delivering age-friendly, patient-centered care. Rather than working in isolation, laboratory professionals will need to renew a focus on multidisciplinary collaboration.   

“We can seek out and gain understanding of age-friendly principles, take an active approach in multidisciplinary initiatives, and publish findings of these initiatives so that other laboratories can see the broader implications of the work,” Drs. Nelson and Coffey suggest.  

Every day, laboratory professionals directly impact patient care in many ways, such as through risk stratification, early disease detection, public health surveillance, and more. But the healthcare system may still underestimate their influence on patient outcomes.   

“There’s a misconception that pathology and laboratory medicine’s impact on patients’ experience and outcomes is limited to sample collection, ease of laboratory result access, and staff-patient interaction,” they say. “We must start stepping outside the laboratory’s four walls to articulate where and how our expertise and work is providing value."  

Part of this involves understanding all the different ways that laboratory care intersects with older patients’ care.   

“That could be anywhere an older adult may navigate on their care path, like cardiology, geriatrics, neurology, or transplant,” Drs. Nelson and Coffey say. “Any space where laboratory data is used, interpreted, and applied — we should be shadowing and hearing directly from the providers. We should be doing the same with patients and how they interact with laboratories pre-analytically and post-analytically. Without clarity on the inflection point, how can we be confident that our efforts are on target and effective?”   

Practical ways laboratories can put ‘What Matters’ into action  

Drs. Nelson and Coffey share several examples of how laboratories can directly support age-friendly, patient-centered care.   

One method is engaging in active partnerships to develop protocols for expanded access to palliative blood transfusions, as outlined under the Hospice CARE Act. They acknowledge that this may feel counterintuitive in some ways given issues like national blood shortages, staffing pressures, and reimbursement concerns. But aligning transfusion decisions with patient priorities could make a significant difference.   

“There’s literature in support of this practice as it’s attributed to enhanced quality of life, reduction in major depression, and overall lower healthcare expenditures,” they say. “But for the patients, ‘What Matters’ may be alleviating symptoms like fatigue and shortness of breath, which impact their ability to live more actively during end-of-life care.”  

Another example is reassessing the value of certain biomarker tests, like Alzheimer’s disease markers, for older adults with advanced dementia or near the end of life.   

“Are these tests necessary for older adults already experiencing advanced dementia at end of life, considering the added stress blood draws can bring to the family and patient?” they ask. “And what are we going to do with the results?”   

Drs. Nelson and Coffey also shared two concrete examples of how laboratories can collaborate with care teams to ensure diagnostics are necessary for older patients:  

1.  Use of best-practice alerts to reduce inappropriate urine culture testing in older adults, which can lead to inappropriate antibiotic use and high rates of multi-drug-resistant infections. 

2.  Implement stronger therapeutic drug monitoring in older adults in non-home environments, like skilled nursing, and long-term care. This might help avoid undetected issues that can lead to treatment failures, drug-drug interactions, or even drug toxicity.  

How your laboratory can get started with age-friendly care  

Adopting an age-friendly approach may sound daunting, but laboratory professionals don’t need to overhaul their entire workflow to begin aligning with a “What Matters” focus. Drs. Nelson and Coffey recommend starting small and focusing on quality improvement strategies that can enhance patient experiences and foster collaboration.   

You can begin by simply assessing how older adults interact with your laboratory, knowing that even modest adjustments can be impactful.   

“Older adults’ health literacy isn’t solely associated with their level of cognitive understanding,” they say. “So, something as simple as reviewing signage, collection instructions, directional signs, hearing, and vision accommodations, and even scheduling considerations for alertness could make a big difference for a laboratory of any size.” 

And consider collaborating with physician teams to provide older adults with more face-to-face time with PhD practitioners, DCLS and pathologists (e.g. Pathology Clinics, direct portal communication, etc.), so patients and their families can more easily get answers to laboratory-specific questions. For Medical Laboratory Scientists looking to get involved, offering laboratory tours and participation in local community education events allow for direct patient interaction.   

While adopting an age-friendly approach has significant benefits, Drs. Nelson and Coffey acknowledge that laboratories may face some hurdles along the way.   

One of the biggest is stakeholder buy-in. Health systems may hesitate to change workflows without clear evidence of value. Providing examples can help.   

“Healthcare systems need only look to other health systems that have incorporated the age-friendly models to see evidence of value,” they say. “Helping older adults helps everyone.”   

Looking ahead  

Drs. Nelson and Coffey believe that research studying the effects of laboratory consults on palliative care and poor prognostication planning could help make the case for the laboratory’s critical role.   

And clearer guidelines are a must.   

“Developing an age-friendly compendium of standardized diagnostic guidelines and recommendations would be beneficial, along with informatics-based solutions that integrate age-friendly best practices into daily practice workflows,” they suggest.   

Laboratories have a unique opportunity to shape age friendly care. Even small changes, such as  reassessing testing frequency, changing laboratory signage, and collaborating more with other care teams, can help laboratory professionals position themselves as leaders in the “What Matters” movement.