This article provides a review of extant literature on Motivational Interviewing (MI) and its effect on medical/biopsychosocial treatment regimen adherence and general health outcomes in the geriatric population (>65 years). This is the first comprehensive literature review study exploring the effects of MI on older adults representative of typical age group seen in geriatrics clinics (i.e., >65 years, with many patients well into their 70s and 80s).The goal of the review is to provide readers with a focused, up-to-date outcome research review and to discuss the feasibility of clinical applications of MI within an interdisciplinary geriatric clinical settings and its adaptation for use with older individuals dealing with both mental health and general medical conditions. To be included in this review, studies had to be randomized controlled design, examine the effects of Motivational Interviewing, and include participants with an average age of 65 years or more. Though limited in number, 7 out of 9 studies reviewed showed a significant improvement in health outcomes as a result of Motivational Interviewing treatment. The two studies that showed no significant improvements included telephone-based MI counseling rather than face-to-face MI treatment. MI shows promise as an effective treatment in affecting health behavioral change for older adults, but further studies are needed to identify key necessary therapeutic features of the MI with this population.

Keywords: Motivational interviewing; Systematic review; Medical regimen adherence; Older adults; Geriatrics; Geriatric patients; MI; Motivational interviewing treatment

Based on the World Health Organization report [1] the number of people aged 65 or older is projected to grow from an estimated 524 million in 2010 to nearly 1.5 billion in 2050, with most of the increase in developing countries. In the United States, increased percentage of the older adults is observed across various healthcare systems. The United States Census of 2010 data reported [2] predict doubling of U.S. population aged 65 and older, between years 2010 to 2050. According to the VA Office of Policy and Planning more than 46 percent of veterans were projected to be 65 years old or older by 2015. Further, based on the Survey of Enrollees’ Health and Reliance Upon VA [3] those aged 65 years or older constitute 3,135,490 VHA enrollees or 42.7% of total VISN enrollees. With an increasing number of veterans who are 65 years old or older, as well as increases around the world, there is a greater need to understand if non-pharmacologic treatment such as Motivational Interviewing, that has been extensively proven as effective in medical care setting and researched among general public with estimated 5,931 articles published on MI in medical care setting (e.g., Lundahl et al. [4]). Although MI has been researched extensively in general public due to its relatively quick effects (often 5 sessions may produce significant results in health behavior outcomes) and associated cost-effectiveness, it has been scarcely researched as a potential treatment or an adjunctive therapy with geriatric population (>65 years). While some studies have looked at MI’s effects in treating “older populations” and even medication adherence (e.g., Depp et al. [5]) those studies varied in their definition of who “older” population is, with mean ages of participants ranging from 50 to 60 years. The only review published in recent years that focused specifically on effects of Motivational Interviewing on behavioral change in older adults [6] included studies with the mean age of the sample to exceed 50 years in the review. While these studies are generally useful they are not entirely representative of typical age group seen in geriatrics clinics (i.e., >65 years, with many patients well into their 70s and 80s).

This study was able to perform a review of literature and include 9 studies which met the inclusion criteria: the mean age of participant sample to be minimum of 65 years and that the study be randomized and controlled. The main purpose of this article is to assess the extant research literature on the efficacy of MI for promoting behavioral health changes among older adults over 65 years old, who are the most likely to visit geriatrics clinics.

To examine the effect of Motivational Interviewing (MI) on functional changes and medical/biopsychosocial treatment regiment adherence among older adults, a comprehensive review of the literature was conducted in July 2013. Research reports were identified from the following databases: PubMed, MedLine, PsychINFO, Social Work Abstracts, Sociological Abstracts, Social Service Abstracts, CINAHL, Health Source: Nursing/Academic Edition. Further, the term “older adults” was used to search the Motivational Interviewing Network of Trainers (MINT, 2014), an MI-related bibliography database. The MINT search yielded a total of 11 articles with publications from 2009 to 2011. Other search terms were “Motivational Interviewing,” “MI,” “older adults,” “adherence,” and “geriatrics.” Only articles meeting the following criteria were included in this systemic review: the average age of the participants must be equal to or exceed 65 years, and the research design must be a randomized controlled study. A total of 9 studies investigating the effect of MI among older adults (> 65 years) were identified as meeting the inclusion criteria and were included in this systemic review.

Of the 9 studies reviewed in this article only 2 studies reported no statistically significant difference (Table 1). Indeed, the two studies which did not find significant effects of the MI on outcomes both shared similar characteristics: low frequency of follow up MI sessions and phone call delivery of MI interventions. For example, Sims et al. [15] reported delivering only initial MI session as a face-to-face session, with remaining two follow up sessions being delivered by primary care nurse over the phone. Similarly, Solomon et al. [16] found no significant effects on medication adherence for osteoporosis patients using a telephonic motivational interviewing intervention which included 10 calls over the course of 12 months.

Unlike the two studies that yielded no significant effects, the other 7 studies (Table 1) demonstrated that participants receiving MI interventions obtained significantly higher scores on outcome measures compared to those who received treatment as usual (TAU). In addition to more face-to-face delivery of MI interventions, these studies also listed higher dosage of treatment and reported 8 weekly home-based MI sessions (e.g., Brodie & Brodie et al. [7,8]).

To be effective, MI must be provided in a flexible and adjustable manner. Further, as review of extant literature in this article suggest, higher frequency of face-to-face MI interventions, along with overall higher frequency of follow-up sessions is more likely to yield desired therapeutic outcomes. Clinicians need to acknowledge specific needs of the individuals as well as populations they are treating and to fit these needs into development and delivery of MI intervention [17,18].

In summary, this article provided a review of extant literature on Motivational Interviewing (MI) and its effect on medical/biopsychosocial treatment regimen adherence and general health outcomes in the geriatric population (>65 years), and as such is the first comprehensive literature review study exploring the effects of MI on older adults representative of typical age group seen in geriatrics clinics (i.e., >65 years, with many patients well into their 70s and 80s). However, given relatively small sample size of studies reviewed it is suggested that further studies on this topic be conducted to better understand and evaluate usefulness of MI based interventions with the geriatric populations.