Author
CUMMINGS Sherry M.; COOPER R. Lyle; CASSIE Kim M.
Motivational interviewing to affect behavioral change in older adults.
Journal citation/publication details
Research on Social Work Practice, 19(2), March 2009, pp.195-204.
Summary
Fifteen randomised controlled trials, including three from the UK, are reviewed and provide preliminary evidence for the benefits of motivational interviewing as a technique for promoting physical activity, improved diet, weight loss, smoking cessation and other factors related to better health in later life.
Context
Many of the acute and chronic illnesses suffered in later life can be prevented or managed through lifestyle changes, but modifying one’s behaviour can be difficult without support. Motivational interviewing is one client-centred approach to behavioural change, and this review focuses specifically on the small amount of existing literature that examines its use with older people.
Methods
What sources were used?
The following databases were searched in June 2007: PsycINFO; Pub Med; Social Science Abstracts; Social Service Abstracts; and Sociological Abstracts.
What search terms/strategies were used?
The terms used were: motivational interviewing; motivational enhancement therapy; elder*; old*; adult*; aged; heart disease; chronic illness; diabetes; chronic diseases; smoking; diet; exercise; alcohol; hyperlidemia; hypertension. The asterisk is used to pick up variant word endings. There is no indication of how the terms were combined.
What criteria were used to decide on which studies to include?
Eligible studies were randomised controlled trials conducted using samples with an average age of over 50.
Who decided on their relevance and quality?
This is not reported.
How many studies were included and where were they from?
Fifteen studies met the inclusion criteria and are summarised in Table 1. Geographical origins are not given in all cases but the studies include three conducted in the UK. Note that a study of African-American smokers (Hyman et al, 2007) is erroneously listed as a UK study.
How were the study findings combined?
The synthesis of evidence is narrative, based around the foci of intervention.
Findings of the review
Diet, exercise and weight control
This topic accounts for much of the identified research, with studies covering: people with adult-onset diabetes (3); people with, or at risk of, heart disease (2); long term cancer survivors (1); and older people without a specific diagnosis (2). One of the diabetes studies showed significant short term weight loss and improved glycaemic control in the intervention group. The second (UK study) produced a significantly higher increase in the frequency and duration of physical activity in the intervention group, while another found that the intervention group improved monitoring and control of their condition but lost no more weight than the control group. Of the two heart disease studies, one showed no significant differences between the treatment and control groups in physical activity, while in the other the intervention group experienced a significant improvement. One of the studies of older people without a specific diagnosis showed a positive effect on physical activity from motivational interviewing, as did the cancer study, while the other (a UK study) found no difference between the intervention and control groups.
Chronic disease management
Three studies examined the effect of motivational interviewing on the management of chronic disease. An intervention to address smoking, diet and exercise among 230 African-American smokers with hypertension and a high risk of cardiovascular disease found that a programme to address all three behaviours was more successful than usual care or a programme addressing the behaviours sequentially. A UK study of 120 people awaiting bypass surgery found that the intervention group performed better in respect of smoking cessation, weight loss, physical activity and blood pressure. Another US study of 111 people with a variety of chronic diseases found significantly less health distress and less illness interference in the intervention group.
Smoking cessation
Three studies addressed smoking cessation. An Australian study found no differences between smoking cessation rates among cancer patients although the treatment group were more likely to use nicotine replacement therapy. Of two US studies, one found a reduction in smoking among people with diabetes after three months, but no significant differences between treatment and control groups at six months. The second also reported positive effects on smokers receiving home nursing care, with statistically significant differences in smoking reduction or cessation between the treatment and control groups at two, six and twelve moths follow-up.
Alcohol consumption
One US study examined the effect of a brief intervention, motivational interviewing or usual care on 45 people aged 65 or more. Although a trend towards decreased alcohol consumption was found in the intervention groups, neither was found to be more effective than the other and neither was statistically different from usual care.
Authors' conclusions
The evidence base on motivational interviewing as a way of encouraging sustained behaviour change is limited and ‘the studies reviewed produced conflicting results’. This may be because of differences in the amount of treatment delivered and the specific intervention model applied in different studies. Nonetheless, motivational interviewing has been found to produce significant changes in areas of significance to the health of older people.
Further research is needed to establish the most effective techniques and dosage rates. Motivational interviewing has been recommended in part because of its brevity and relative low cost, but the evidence suggests ‘that there may be a minimum dose that is needed to enhance long-term efficacy with older adults’. Future studies should provide clear descriptions of interventions, and consider sociodemographic factors such as ethnicity, gender and socioeconomic status that may influence outcomes.
Implications for policy or practice
Given the serious negative effects of problem behaviours, the evidence identified by the review ‘should be seriously considered’. It shows not only that motivational interviewing can have a positive impact in a relatively short time, but also that it is acceptable to older people. The integration of this technique into social work education courses and in-service training is warranted.
The evidence also points to the superior efficacy of interventions that address multiple problems simultaneously rather than sequentially.
Related references
None.