Background <p>Healthcare professionals experience challenges in eliciting what really matters to older adults in person-centered care with shared decision-making. The framework of internal and external connectedness to life is a promising model for explicating individual values and preferences. We aimed to explore the relation between this framework and what really matters to older adults in life and treatment.</p> Methods <p>This qualitative study followed a thematic content analysis of 25 interviews with heterogeneous older adults aged ≥ 70 years in the Netherlands.</p> Results <p>Our analyses identified four themes. First, participants (mean age, 80 years, range 70–99 years) considered feeling connected to life to play a vital role in life, disease and treatment-decisions. Participants connected to life differently through personally meaningful activities in line with their own connectedness orientation. The extent to which participants felt connected to life differed. Second, their acceptance of life’s finiteness differed equally. Third, both their connection to life and acceptance of its finiteness colored participants’ overall willingness to be treated and their treatment goals. Fourth, multiple factors were described as disconnecting (physical suffering, unenjoyment food, non-recognition self, living context), while relationality between healthcare provider and receiver was considered connecting. Accordingly, these factors mediated treatment decisions.</p> Conclusions <p>Older adults’ overall willingness to be treated and subsequent treatment goals are colored by the extent to which they feel connected to life and accept life’s finiteness. The framework of connectedness to life could provide healthcare professionals with words to elicit and interpret what really matters to older adults during clinical decision-making, and therefore help tailor person-centered care.</p>