Increasing Older Adult Involvement in Geriatric Assessment: A Mixed-Methods Process Evaluation

Area of Science:

• Gerontology
• Behavioral Science
• Health Services Research

Background:

• Goal setting and motivational interviewing (MI) are recognized techniques for promoting healthy behaviors and enhancing well-being.
• Previous interventions utilizing these methods in community-dwelling older adults did not demonstrate improved well-being.
• The current study investigated implementation processes as a potential explanation for the lack of observed benefits.

Purpose of the Study:

• To evaluate the implementation quality of goal setting and MI within a geriatric assessment service for older adults.
• To identify factors contributing to the suboptimal application of these behavioral change techniques.
• To understand how implementation challenges might impact the potential for improved well-being.

Main Methods:

• Goals set during comprehensive geriatric assessments were analyzed for their behavior-change potential.
• Adherence to goal setting and MI principles was assessed through review of audiotaped interactions.
• Interviews with care professionals were conducted to gather insights on implementation barriers.

Main Results:

• Over 90% of the 280 goals set for 230 frail older adults had low potential for behavior change.
• Quality benchmarks for MI were met in only one of eleven assessed interactions.
• Implementation was constrained by contextual factors and limited proficiency of care professionals.

Conclusions:

• The implementation of goal setting and MI in this proactive assessment service was suboptimal.
• Barriers related to goal quality, MI fidelity, and professional competence significantly limited the effectiveness of the intervention.
• Suboptimal implementation likely diminished the potential for enhancing the well-being of participating older adults.