Association between community-level health literacy and frailty in community-dwelling older adults.

Abstract

We aimed to investigate whether high community-level health literacy, beyond individual-level health literacy, is associated with a low prevalence of frailty among community-dwelling older adults. A large cross-sectional questionnaire survey was conducted among citizens in Maizuru City, Kyoto, Japan, aged 65years or older who were not certified as "support" or "care" level according to Japan's public long-term care insurance system, who could perform basic activities of daily living, and who did not have dementia or Parkinson's disease. Frailty status was assessed using the Kihon Checklist, with a score ≥ 8 indicating frailty. Health literacy was assessed using the Communicative and Critical Health Literacy Scale. The mean health literacy score of 20 school districts was used as the community-level health literacy index. We investigated demographic data and other potential confounding factors, including education, living arrangement, body mass index, comorbidity, smoking status, depressive symptoms, social networks, and community-level covariates. The primary analysis included 6230 individuals (mean age = 74.3years [SD = 6.1]). In each school district, the prevalence of frailty was 21.2-34.2% (mean: 26.2%), and community-level health literacy index was 3.1-3.5 (mean: 3.4). Multilevel logistic regression model including school district as random effect showed that the community-level health literacy was significantly associated with frailty (odds ratio [95% confidence interval] = 0.28 [0.08 to 0.96]) after adjusting for the covariates. Not only high individual-level health literacy but also high community-level health literacy is associated with a low prevalence of frailty in community-dwelling older adults.