The University of New Mexico Health Sciences Center

SCHOOL OF MEDICINE

Applying Motivational Interviewing

to Geriatric Medicine
Keri Bolton Oetzel, Ph.D., MPH
Carla Herman, MD, MPH
Lisa Gibbs, MD
Supported by a grant from the Donald W. Reynolds Foundation
 Objectives
• Identify at least three approaches to effective
communication
• Assess a patient’s readiness to change
• Determine how this assessment of readiness to
change can be used clinically to develop
constructive dialogue about behavior change
• Identify case examples in the care of older adults
and/or their caregivers suitable for MI techniques
 Definition of MI
• “A person-centered, directive method of
communication for enhancing intrinsic
motivation to change by helping clients
explore and resolve ambivalence.”

Miller & Rollnick (2002)

How is MI Different?
 Why Use MI?
• 1st meeting matters!
• MI + Active treatment
• Bigger effect with minority samples than with
Anglo/White samples
• Broadly applicable
• Increases treatment retention
• Increases treatment adherence
 Studies of Interest
• MI & Cardiac Care (Watkins et al, 2007)
– n=411
– MI leads to improvement in patient mood 3
months post stroke
• Adherence to Medication (Solomon et al,
2010)
– n=879
– MI leads to improved medication adherence for
people with osteoporosis
 Studies of Interest Continued
• Anxiety & Older Adults (Stanley et al, 2009)
– n=134
– CBT with MI resulted in greater improvement in
worry severity, depressive symptoms, and general
mental health
 MI in Geriatrics
• Using a walker
• Moving into assisted living
• Stopping driving
• Decreasing drinking
• Attending day care
• Talking with family members, inviting family
members to engage in a different way
• End-of-life discussions
 Spirit of MI
• Develop Discrepancy
• Avoid Argumentation
• Roll with Resistance
• Express Empathy
• Support Self-efficacy
 Develop Discrepancy
• Awareness of consequences is important
• A discrepancy between present behavior and
important goals will motivate change
• The patient should present the arguments for
change
 Avoid Argumentation
• Arguments are counter productive
• Defending breeds defensiveness
• Resistance is a signal to change strategies
 Roll with Resistance
• Momentum can be used to good advantage
• Perceptions can be shifted
• New perspectives are invited but not imposed
• The patient is a valuable resource in finding
solutions to problems
 Express Empathy
• Acceptance facilitates change
• Skillful reflective listening is fundamental
• Ambivalence is normal
• Respond to a patient’s ambivalence as
understandable, comprehensible, and valid
 Support Self-efficacy
• Belief in the possibility of change is an
important motivator
• The patient is responsible for choosing and
carrying out personal change
• There is hope in the range of alternative
approaches available
 Helpful Skills
• Using And vs But
• Asking Permission
• Assessing Readiness/Importance/Confidence
 And versus But
But… And…
• I want my dad to be • I want my dad to be
healthy, but… healthy and I don’t want
to deprive him
• It might be a problem, • It might be a problem and
but everyone in my I am confused because
family… everyone in my family has
diabetes
• You’ve made a lot of • You’ve made a lot of
changes, but… changes, and some things
are more difficult than
others
Advice Giving & Asking Permission
• MI adherent only if you have permission
– Ask permission
– They ask for it
– Give permission to disregard it
 Assessing Readiness to Change
• On a scale of 0-10, how ready are you to think
about________?

0 1 2 3 4 5 6 7 8 9 10

• Backward question: Why a 5 and not a 3?

• Straight question: Why a 5?
• Forward question: What would it take for you
to move from a 5 to 7?
 Future Directions
• Inter-professional Model
• Teaching MI/Core Faculty
• Using MI in Teams
• Curriculum for MI in Geriatrics
• SIM Labs