Authored by Joseph M. Casciani, PhD
In the field of aging, when we talk about reducing resistance, an important distinction has been made between compliance and adherence. Compliance has the connotation of authority. Subordinating to the person or system in authority often brings with it a measure of distrust and resentment. Adherence, on the other hand, does not carry the same connotation of enforcement and subordination. Rather, it implies more of a collaborative effort and dialogue between the advisor and client.
A third popular term, especially in the United Kingdom, is concordance. This refers to greater involvement of the client in the treatment process. This includes more information about care options and more of a trusting two-way collaboration between parties.
This trend toward greater collaboration is a positive development. The more an older adult is engaged in his or her own care and connection with their community, the more likely it is to have a lasting effect.
Improving Collaboration to Reduce Resistance
Several elements make up the collaborative process, including the following:
- Empathy, understanding, and two-way communication: Respect the client’s autonomy and decision making. Accept his or her mindset and the values, perceptions, and feelings that accompany this position.
- Give the older adult permission. Remind the client that he or she has choices. Importantly, strengthen the elder’s sense of empowerment, helping him or her to reclaim a feeling of control over the environment.
- Good listening skills: The first stage in overcoming resistance is to listen to the individual’s position without passing judgment. This creates a climate for change, and opens the door to considering alternative views and ideas. This entails listening to the reasons for the resistance. It may be the lack of trust, the poor coping ability, or the attempts to hold on to control. It does not mean offering a quick fix because if there were a quick fix, it would have worked already.
A Modified Motivational Interviewing Approach
- Point out discrepancies. Sometimes an elder voices new goals and a desire for change yet continues to demonstrate the original behaviors. In these instances, it can be useful to point out the discrepancies between the goal and the behavior. In effect, this results in having the elder explain the remaining resistance in his or her own terms. And from his or her own perspective.
- Value self-directed behavior over externally directed behavior: Two factors come into play. First, the importance of change. Second, the confidence the individual has in his ability to bring about a change (e.g., self-efficacy). Assess and reassess the importance of change and self-efficacy on a scale from 1 to 10 during each conversation. This becomes an accurate and reliable predictor of successful change that is initiated from within.
- Roll with resistance: Resist pushing an older adult before he or she is ready. Push and the individual pushes back.
Solution-Oriented Focus
- Focus on solutions. Have the elder describe what will be different after the change occurs or when adhering to the prescription. How will he or she know that the recommended plan is being followed? How will others know? After identifying what the client will do differently, recommend that he or she engages in that new behavior. Here is an example of the solution-oriented approach: “Well, if I were watching my diet like I’ve been told,” she may say, “I would get up every morning and plan my meals for the day ahead of time.” If the client adopts this approach and engages in this new behavior, it occurs whether the desire or intent is present at all. And, with even minimum reinforcement, it is likely to be repeated. This illustrates how a new behavior can change one’s thinking rather than the other way around.
- Monitor the elder’s cognitive functioning. If there are mental barriers or cognitive limitations to the individual’s understanding about the reasons for change, explore other approaches.
- Mobilize family and other caregivers. Informal, unpaid caregivers have an opportunity to support the elder in his or her behavior change. This is done by acknowledging and reinforcing movement in a positive direction. Caregivers can also strengthen the importance of the change and help build the client’s confidence to carry out the change. Others can more easily accomplish this attention, reinforcement, and support when they are included in the process.
Conclusion
In conclusion, it is important to recognize the validity of resistance in older adults. It is also important to be mindful of the importance of a caring, competent approach when attempting to reduce this resistance. And with these in mind, it is possible to overcome this barrier to successful aging.
This excerpt is from an article that was originally published in Aging Well Magazine, Fall, 2008. The content applied to individuals in long term care settings. However, the themes and principles discussed extend beyond long term care.
This article is referenced in the Living to 100 Club’s new publication: Better, Longer & Happier: A Guide to Aging with Purpose and Positivity.