Motivational interviewing for older adults in primary care: A systematic review

doi:10.1016/j.gerinurse.2014.02.002

Geriatric Nursing

Volume 35, Issue 3, May–June 2014, Pages 219-224

https://doi.org/10.1016/j.gerinurse.2014.02.002 Get rights and content

Abstract

Chronic disease is now the leading cause of death and disability in United States. Many chronic illnesses experienced by older adults can be prevented or managed through behavior change, making patient counseling an essential component of disease prevention and management. Motivational Interviewing (MI), a type of conversational method, has been effective in eliciting health behavior changes in people in a variety of settings and may also be a useful tool to help older adults change. This review of the literature analyzes current research and describes potential biases of MI interventions that have been conducted in primary care settings with older adults. MI shows promise as a technique to elicit health behavior change among older adults. However, further study with this population is needed to evaluate efficacy of MI interventions in primary care settings.

Section snippets

Background

Advances in public health, such as improved sanitation, antibiotics, and vaccinations have contributed to a dramatic reduction in death and disability from infectious disease. As a result, people in the developed world are living longer. Longer life spans increase the likelihood of acquiring chronic illness, the leading cause of death and disability in the US.¹ While 80% of Americans have at least one chronic health condition, aging does not inevitably lead to poor health.² Many chronic

Objective

As understanding grows about the relationships between behavior change and health status improvement for older adults, it is important to determine if MI can be successful in helping this population achieve and sustain behavior change that will lead to improved health outcomes. The purpose of this paper is to systematically review research studies in which MI interventions were used to elicit health-related behavior change among older adults in primary care settings.

Review methods

We conducted a review of studies published before October 2013. Databases searched included ProQuest Dissertations and Theses, Medline, PsycInfo, and CINAHL^®. The PICOS criteria (Participants/Problems, Intervention, Comparison/Control group, Outcomes, Study design) guided the search, retrieval, and review process.¹⁵ Key words included Motivational Interviewing; health behavior change; and primary care, joined with “and” as a Boolean operator. Additional relevant research was identified using

Results

The search yielded 42 papers, 36 of which were found in the initial electronic database search. An additional 6 studies were located using ancestry. After screening all abstracts, 2 duplicates and 26 articles that did not meet the inclusion criteria were rejected, leaving 8 articles for inclusion in this systematic review. Fig. 1 provides a summary of the retrieval flow and study results are summarized in Table 1.

Related to review findings

This review of eight studies that evaluated the use of MI with older adults indicates that MI may be effective when incorporated into health promotion and disease prevention interventions. Further, the use of MI may have potential as an application across diverse professionals and health care settings. These findings should be viewed cautiously, because few studies reported MI interventions in sufficient detail to allow the reader to determine intervention quality. MI is heavily influenced by

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Digital health interventions (DHI) involve multiple interactions between the user, technology platform, and study team, posing challenges for implementation. This paper describes the lessons learned while implementing an internet-based randomized controlled trial (RCT) for reducing depression symptom burden in older acutely-bereaved adults.
The RCT was entitled “Widowed Elders' Lifestyle after Loss” (or WELL), which compared the efficacy of a DHI to an enhanced usual care (EUC) for reducing depression symptoms in adults 60+ years who lost their spouse/life partner within the previous 12 months. Participants randomized to the DHI used their own tablet, smartphone, or pc to record the timing and regularity of sleep, meals, and physical activity twice daily, for 12 weeks. The also received weekly health coaching sessions from a clinician certified in motivational interviewing. Participants randomized to the EUC arm received weekly calls from research staff and were assessed on the same schedule as intervention participants. All study procedures were conducted virtually. Methodological and procedural challenges were discussed weekly with study staff and the primary investigator.
Many challenges can be categorized as follows recruiting virtually, obtaining informed consent, training older adults to use technology, and establishing rapport with older adults. Solutions required researcher and interventionist flexibility in adapting to new strategies. For instance, we redesigned the informed consent process to include a user-friendly brochure that enhanced participants' understanding of the RCT and improved our enrollment rate. We also utilized user-engagement in refining an intervention protocol.
We resolved implementation challenges without compromising internal validity via interdisciplinary collaborations with mobile programmers to ensure our technology met the unique and varied needs of aging users. The solutions from this study may promote the recruitment and retainment of older adults in research studies that use technology-based interventions.
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Motivational interviewing, in particular, is a communication method that uses client-centered counseling to elicit motivation and reduce ambivalence for behavior change; it seeks to strengthen the client's motivations for change and follows a concrete plan of action in an evocative and collaborative setting. This technique was found useful for older adults within the primary care setting.56,57 Alternatively, those with more severe SUDs tend to require intensive treatments.
Motivating the patient with kidney disease to nutrition adherence and other healthy lifestyle activities
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Patients with kidney disease must implement and sustain nutritional and other lifestyle changes and adhere to prescribed medical treatments to best manage their health. An important strategy for health-care providers to promote these activities is to activate the patients’ motivation for behavior change. This chapter describes an approach for talking with patients, called motivational interviewing (MI), to achieve this purpose. MI is an evidence-based practice that is widely used in health-care settings to counsel patients with chronic diseases. This chapter describes what MI is and is not, its basic principles and techniques, empirical support, published applications of MI for improving kidney disease patients’ self-management, how to learn MI, dissemination of the approach, and future research directions for studying MI for use with kidney disease patients. Research is needed to determine the efficacy of MI for the promotion of self-management among patients with kidney disease and to develop innovative ways to train busy health-care providers in the approach.
Effectiveness of motivational interviewing in enhancing cancer screening uptake amongst average-risk individuals: A systematic review
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Citation Excerpt :
Furthermore, clients’ awareness, confidence and willingness to change are challenges from the clients’ perspective that may also limit the effects of motivational interviewing on behavioural change (Hogden et al., 2012). Motivational interviewing has been used to manage both risky and preventive health behaviours amongst older adults, younger adults and adolescents (Jensen et al., 2011, Lundahl et al., 2013, Purath et al., 2014, VanBuskirk and Wetherell, 2014). It has also been used among cancer patients to manage cancer-related symptoms (Spencer and Wheeler, 2016).
Although cancer is a worldwide public health problem, it can be detected early and prevented through cancer screening. Recommendations for screening methods and screening intervals are currently available for several types of cancer. However, not all average-risk individuals are motivated to undergo cancer screening.
To examine the effectiveness of motivational interviewing that targets average-risk individuals regarding their cancer screening intention and uptake and to provide recommendations for the content and format of motivational interviewing based on the existing evidence.
A systematic literature search was performed using four databases and a manual search. A combination of keywords including ‘motivational interviewing’, ‘cancer screening’, ‘screening intention’ and ‘screening uptake’ were used to identify relevant articles. Only randomised controlled trials that examined the effects of motivational interviewing amongst average-risk individuals were included in the review. The Cochrane Risk of Bias Tool was used to appraise the methodological quality of the selected articles. The findings were summarised in narrative and tabular formats.
Six randomised controlled trials that used motivational interviewing to enhance cancer screening uptake or intention were included in the review. The findings show that motivational interviewing that used a face-to-face and telephone-based approach or were used together with a tailored or reminder letter enhanced the participants’ uptake of breast and cervical cancer screening and their intention to undergo future cervical cancer screening. Mixed results were observed in the effectiveness of single-contact motivational interviewing on colorectal cancer screening.
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Although primary care providers care for older adults, the lack of specific geriatric training can be problematic in delivering behavioral change interventions. First, motivational interviewing, a core tenet in eliciting change and in the Medicare Obesity Benefit, is heavily influenced by the contextual aspects of delivery and by clinicians,97 and internists may approach elements differently than geriatricians. Second, geropsychological principles are often not integrated in routine interventions,98 including social participation, which is strongly related to better health and can lead to forming new goals in people’s lives.99
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This paper describes the design and rationale of an intervention development study addressing selective and indicated prevention of depression, anxiety, and/or complicated grief disorder(s) among adults 60 years and older who are grieving the recent loss (within 8 months) of a spouse or partner.
In Phase I, now complete, we developed and standardized behavioral self-monitoring of daily lifestyle choices via an electronic diary (BSM) and the combined BSM + motivational interviewing-based lifestyle coaching (BSM + MI) to be administered to participants grieving the loss of loved one. In Phase II, we have been implementing the interventions in a randomized controlled trial and addressing challenges related to recruitment. Randomization is to one of three cells: BSM, BSM + MI, or an enhanced usual care condition.
Several challenges in implementing our lifestyle interventions to older widow(er)s who are at risk for common mental disorders have been identified. Direct outreach to hospice organizations is an effective way to identify older adults in the early months following spousal death. Results from study may advance the field of grief support and promote a healthy adaptation to widowhood.

View all citing articles on Scopus

: Funding: No additional funding from any source was provided to the authors of this systematic review.

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Feature ArticleMotivational interviewing for older adults in primary care: A systematic review

Abstract

Section snippets

Background

Objective

Review methods

Results

Related to review findings

Healthy Aging: Helping People to Live Long and Productive Lives and Enjoy a Good Quality of Life

Motivational interviewing with problem drinkers

Behav Psychother

Motivational Interviewing in Health Care: Helping Patients Change Behavior

What's New Since MI-2?

Functional health: innovations in research on physical activity with older adults

Med Sci Sports Exerc

Patients prefer the method of ‘tell back-collaborative inquiry to assess understanding of medical information’

J Am Board Fam Med

Older adults' strategic behavior: effects of individual versus collaborative cognitive training

Educ Gerontol

Motivational Interviewing: Helping People Change