# Diet and Oral Health Coaching Methods and Models for the Independent Elderly
## 6 Oral Health Coaching
### OARS Model in MI
#### 6.1.2 Other Models and Tools for Immediate Senior Oral Health Coaching
Those patients whose recall and comprehension were assessed were more likely to have hemoglobin A1c levels below the mean [147]. Finally, the Closing the Loop technique was not found to add time to the visit duration [147] and, as such, could be of service at a busy dental office or senior center. Rating of Change Check  
It is said that patients are more likely to succeed with a health behavior change when the change can be related to a matter that is important to them and other people they care about (grandchildren, friends in certain activities, etc.) and when they are confident that they can achieve the change. This is a point that is very important for OA who feel their competencies to decrease. Simple ratings of level of importance and confidence using a scale of 0 to 10 can give a quick indication of readiness and next steps. Ratings of less than 7 on either measure signify less likelihood of success and the need to explore concerns and barriers with the patient, or even to select a different topic for health behavior change [10; 122]. In this modality, it is important to know that there should be avoidance of the use of scare tactics, lectures, or direct warnings, as some people might pretend to agree in order to not be further attacked. Effective questions on this part of the session would be: _\"Why would you want to make this change?\" or \"How might you go about it, in order to succeed?\" or \"Do you think it will help you to have strong teeth when you talk or smile?\" or \"How about being able to talk without embarrassment of having no teeth in front of your friends/grandchildren?\" or \"Do you understand that by eating so much sugar you'll end up having no teeth when you will need them most? \"What are the three best reasons for you to do it?\" or \"How important is it for you to make this change?\" or \"So what do you think you'll do towards... \"_. Goal setting and action planning can be performed by filling up action planning forms, which are problem-solving forms addressing patients' barriers to achieving success with behavior change and put them in action. Once a health goal is chosen that is important and meaningful to OA, the next step is collaborative work with the dentist/coach to create an action plan, framing small steps that have high likelihood of success. In one study, action planning was found to take as little as 1 or 2 min or as long as 20 min. The average was 6.9 min [137]. Some OA may require a longer visit or additional contacts to help achieve their self-management goals. However, most of them would be best served by a short process that is revisited, improved, and modified over short periods of time due to memory loss. Questions that might be asked in this modality are: _\"When will you know you have succeeded in your goal?\" or \"If you had a magic want, what would you ask for first?\" or \"How do you imagine yourself in six months' time concerning (mention the problem)?\"_  
The problem-solving check list provides a quick assessment tool for grading the steps needed in order to change a habit. OA should write down, with the help of the dental professionals, the identified problems and the proposed solutions in order to overcome barriers [122]. (1) _\"On a scale of 0 to 10, with 0 being not at all confident and 10 being as confident as you can be, how confident are you that you can (describe the activities on the action plan here)?\"_. Depending on the patient's answer, ask follow-up questions. _(\"What makes you say 6?\" or \"What led you to rate it as high as a 6?\" or \"What has helped you to be confident in the past?\" or \"What might help you get to a 7 or 8?\"or \"What could I do to help you feel more confident?\")_ (2) Anticipate barriers and consider strategies to overcome them.