Motivational Strategies to Prevent Frailty in Older Adults with Diabetes: A Focused Review

Table 1

Application of motivational strategies and likelihood of following recommendations to manage diabetes and prevent frailty.

HBM construct	MI construct	Modifying factors	Application	Likelihood of action
Perceived susceptibility	Partnership	Age, sex, ethnicity, personality, socioeconomics, and knowledge	Clinician works with client to explain vulnerability consequences: risk of falls for persons with diabetes	Perceived benefits outweigh the perceived barriers
Perceived severity	Partnership/empathy	Perceived threat of falls and uncontrolled diabetes	Clinician educates client about frailty and diabetes in relationship to their individual/social background	Likelihood of performing the recommended exercise and nutrition for diabetes self-management and frailty prevention
Perceived benefits	Cultivating change talk/partnership	Cues to action; (i) Education; (ii) Symptoms; (iii) Media	Likelihood of performing the recommended exercise and nutrition for diabetes self-management and frailty prevention; (i) Examples of actions: Participating in strength training for older adults at the senior center; (ii) Increasing lean protein and vegetables while decreasing bread, rice, and pasta	Clinician indicates specifically how exercise and nutrition can improve the client’s quality of life by preventing/reducing frailty and managing blood glucose
Perceived barriers	Softening sustained talk	Physiological and psychological state (depression, stress, and anxiety)Hypoglycemia,cognitive function, fear of falling, and safety		Clinician ignores negative talk and presents solutions
Cues to action	Cultivating change talk/partnership			Clinician provided exercise/nutrition education in conjunction with cognitive, physical and economic limitations; (i) Involves physician in medication timing/dose changes; (ii) Involves social worker and psychiatrist for economic and psychological issues; (iii) Engages client and family/caretakers to discuss what he/she will change and why; (iv) Consider structured programs such as SilverSneakers
Self-efficacy	Empathy			Clinician affirms the client’s abilities

Adapted from Hamrin et al. [64] and Janz et al. [71] Likelihood of action is the outcome of constructs, modifying factors and applications.