Re-Engaging a Client Who Says She Is Too Old and Has Transportation Barriers
72-year-old woman began a 12-week balance program after a near-fall at church. She attended the first six sessions but has missed the last three. When contacted, she says, 'I'm too old to change this; it won't make a difference.' She cares for her husband, who has dementia, and relies on a 40-minute bus ride with one transfer. Her original goal was to stand during the church service and walk to the altar without holding a pew. She reports low confidence and says the exercises are 'boring.' She lives on a fixed income, cannot afford taxis, and stopped gardening two years ago. She has no new pain or dizziness. The program has six weeks remaining.
1. Using motivational interviewing and self-efficacy principles, outline how you would open the conversation and respond to her statement that she is too old to change.
Read the worked answer
Open without persuasion: 'You've missed three sessions, and you're saying this feels pointless. What has changed for you?' Reflect her words, affirm her caregiving effort, and ask permission before discussing the program. Explore importance and confidence on 0-10 scales, then ask what would move confidence up one point. Reframe 'too old' as a reasonable fear of falling and a protective instinct, not a fact. Link exercise to her church goal: standing during the service and walking to the altar. Use self-efficacy sources: mastery with small, guaranteed wins; vicarious support from a peer who uses a cane; verbal encouragement tied to evidence of progress; and reducing physiological arousal by practicing in a quiet, supported space. Do not argue or lecture; evoke her own reasons for re-engaging.
2. Develop a 6-week re-engagement plan that addresses transportation, caregiver burden, and boredom, with measurable checkpoints.
Read the worked answer
Re-engage with one in-person session weekly plus two 10-minute home sessions, because the 40-minute bus trip with a transfer is too heavy for three times weekly. Choose a class time on one bus route, arrange a peer check-in call, and ask whether caregiver respite or a friend can cover one session. Address boredom by turning practice into functional tasks: sit-to-stand during commercials, step practice at the bottom of the stairs, turning practice in the kitchen, and a church-pew simulation using a sturdy chair. Set measurable checkpoints: attend one in-person and two home sessions weekly for 3 weeks; improve confidence rating by at least 2 points; complete five sit-to-stands in 16 seconds or less; walk 30 m with a cane and one head turn. Review at week 2 and week 4; if attendance still fails, problem-solve again rather than discharge.