This article reviews and assesses the existing research literature on the efficacy of motivational interviewing (MI) to promote lifestyle changes and improve functioning among older adults confronting serious health challenges. A comprehensive literature review was conducted of intervention studies that tested the use of MI to achieve behavioral change among older adults with acute and chronic illnesses. Although limited in number, the studies revealed a significant improvement in physical activity, diet, cholesterol, blood pressure and glycemic control, and increased smoking cessation following MI. MI and its derivatives can be useful in dealing with a range of health issues faced by older adults. Further research to extend findings and address methodological issues is recommended. The integration of MI into social work courses focused on practice with older adults should be considered. (Contains 1 table.)