Client motivation is an elusive and vexing problem for many healthcare professionals. "Mr Jones is just not motivated!!" can be a frequently heard complaint. Yet we, as professionals, instead often mean "Mr Jones is not motivated to do what I want him to do or think that he should do." Mr Jones is almost always motivated toward some behavior, just not necessarily what we want as an outcome. Thus, as we look at motivation, we must also consider strategies to modify the client's mindset so that he or she is motivated toward more healthy behaviors or to make a healthy behavior habitual. As several of the articles point out, we must consider not only the client's motivation toward more activity but also the client's motivation toward more sedentary behavior.

The dictionary tells us that "motivation" refers to forces that activate behavior toward satisfying needs or achieving goals. Synonyms include stimulus to action, impulse, and incentive. While motivation is therefore primarily internal within the individual, what we view is the external behavior. Studies on motivation investigate both of these aspects of motivation: why the person chooses a certain behavior and what that behavior is.

Another related concept is adherence or the ability to be consistent, stick to something, or to maintain a behavior. One important aspect of motivation for an individual is this ability to maintain a desired behavior and make it a habit.

Forces behind an individual's motivation can be an interaction of both internal and external factors. External factors may include cultural values, social support, social control, and environmental factors such as weather and safety. One important internal factor is the person's sense of self-efficacy, that is, the belief that one can be successful at a certain goal. Mental health problems such as depression can also affect motivation. More prevalent in the older population are the problems of disability, pain, and poor health, which can limit motivation toward activity. On the other hand, a major health event-which is more common in the later years-can provide a strong motivation to change behavior to improve health.

This edition includes 4 articles examining various aspects of motivation. Wallace and Lahti's article reviews motivation toward physical activity in the older population from the psychological perspective. Several theories of motivation, including self-regulation, social cognitive theory, and the transtheoretical model of change are examined. The authors make numerous practical suggestions for professionals working with older persons. Muse's article looks at more external factors, including demographic and environmental factors. However, she points out that internal factors and approaches to affect those factors are the most frequently successful strategies to motivate the older person toward more healthful behaviors. Both authors emphasize that as the older client moves through the stages of behavioral change from precontemplation to maintenance, the strategies for motivation will also change. The last 2 articles focus on specific subgroups within the elderly population. Edelstein's article uses case studies to examine factors affecting motivation in older persons with amputations. These clients have many barriers to physical activity including depression, pain, and poor health. Edelstein utilizes a cost-benefit equation approach and suggests various strategies to help these clients achieve success. Individualizing each client's program taking into account the history of the client is key to maximizing the benefit side of the equation. The Williams article looks at an especially challenging client group, those with dementia. While dementia is a progressively debilitating disease, strategies are still available to modify behaviors in this group. For this group, medications and caregiver education may also play a key role in motivating behaviors. Enriching environments, personalizing care, and use of visual aids can increase motivation toward activity.

We hope you will finish these articles with a greater insight into the multiple factors that may motivate your older clients, and gain ideas for your everyday practice. As professionals we need to develop individualized approaches to each client, modify our approaches based on the many factors discussed in these articles, and ultimately help our clients to initiate and maintain more healthy behaviors.

Ann Williams, PhD