Health Literacy and English Language Comprehension among Elderly Inpatients at An Urban Safety-Net Hospital

Abstract

Objective To evaluate the relationship between health literacy and age in chronically-ill inpatients at a safety-net hospital. Setting and Participants We recruited 399 English- and Spanish-speaking inpatients being evaluated or treated for Congestive Heart Failure or Coronary Artery Disease at a large, urban safety-net teaching hospital in Southern California. Design Participants were interviewed to ascertain education, English comprehension, and in-home language use. Health literacy was assessed using The Test of Functional Health Literacy in Adults (TOFHLA). We compared by age (aged 65 or more, 51 to 64 years of age, and less than age 50) levels of health literacy, educational attainment, English comprehension, and language use. Results Prevalence of inadequate health literacy significantly increased with increasing age (87.2% in ≥65, 48.9% for 51–64, and 26.3% in ≤50, p<0.001). The correlation between older age and lower health literacy persisted when controlling for educational achievement, race, ethnicity, gender, and immigration status. Additionally, older patients were more likely to have never learned to read (34.9% in ≥65, 6.5% for 51–64, and 1.5% in ≤50, p<0.001), no formal education (27.9% in ≥65, 9.0% for 51–64, and 0.8% in ≤50, p<0.001), have limited English comprehension (74.2% in ≥65, 43.5% for 51–64, and 35.8% in ≤50, p<0.001), and speak a non-English language at home (82.3% in ≥65, 70.2% for 51–64, and 62.2% in ≤50, p=0.015). Conclusions To prepare to meet the chronic disease needs of a growing older patient population, and ameliorate the negative health effects of associated low literacy, safety-net hospital leaders and providers need to prioritize the development and implementation of low-literacy educational materials, programs, and services.