Outcomes of hospitalisation in older adults are not exclusively positive. Mortality rates are high and, after discharge, there are often lasting limitations in daily life. Discussing the desirability of hospitalisation is not yet common practice. In this dissertation is investigated how the decision-making process for hospitalisation occurs, which goals older patients hope to achieve with hospitalisation and how these can be questioned and evaluated. This dissertation revealed that discussing goals is not yet common practice. While goals differ from person to person. It also showed that reported outcomes of goals, i.e. whether personal goals are achieved, are more relevant than outcomes of standard questionnaires such as so-called patient-reported outcome measures (PROMs). An instrument was developed to elicit and evaluate older patients’ goals, in order to attain a personalised outcome measure after hospitalisation. It subsequently proved difficult to evaluate this instrument according to the usual criteria of reliability, validity and responsiveness. After hospitalisation, many older patients had achieved their goals. If outcomes were disappointing, this could lead to acceptance, frustration or remaining hopeful. This depended on personal factors, social factors and influence of caregivers, among others. Achieving goals depended mainly on subjective factors such as patient confidence in achieving goals and perceived quality of life. This makes it important for healthcare providers and patients to talk about goals, hopes, expectations and outcomes, before, during and after hospitalisation. This conversation should form the basis of decision-making.