Health Literacy In Older Adults Research Articles

Health literacy, sociodemographic factors, and cognitive training in the active study of older adults.

Health literacy is critical for understanding information from health-care providers and correct use of medications and includes the capacity to filter other information in navigating health care systems. Older adults with low health literacy exhibit more chronic health conditions, worse physical functioning, and poorer mental health. This study examined the relationship between sociodemographic variables and health literacy, and the impact of cognitive training on change in health literacy over 10years in older adults. Participants (N=2,802) aged 65years and older completed assessments, including reading and numeracy health literacy items, as part of the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study. We evaluated baseline sociodemographic variables and change in health literacy over a 10-year period in individuals exposed to cognitive training in reasoning, processing speed, memory, or a no-contact control condition. Age, sex, race, education level, and general cognitive functioning at baseline were all associated with baseline health literacy in older adults. Predictors of change in health literacy over the 10-year follow-up were age, race, education level, general cognitive functioning, and neighborhood income; disparities in health literacy because of race attenuated over time, while the effect of age increased over time. Health literacy was generally stable across the ACTIVE intervention groups over 10years. The present study showed important disparities in health literacy level and change over 10years. Cognitive training did not significantly impact health literacy, suggesting that alternative approaches are needed to reduce the disparities.

Predictors of mental health literacy in older people

ObjectivesOlder adults exhibit poorer mental health literacy than younger adults, including less accuracy at identifying symptoms of mental disorders, and endorsing fewer sources of treatment for a mental disorder. The current study’s intention was to determine if the executive component of cognition is associated with mental health literacy in older adults, when controlling for other established predictors (sex, age, education, and proximity to someone with a mental disorder). MethodThe sample included 85 cognitively healthy adults aged 60 and over. Participants completed the Mini-Addenbrooke’s Cognitive Examination III, the Trail Making Test, a Phonemic Verbal Fluency Test, and the Mental Health Literacy Scale. ResultsA multiple regression indicated that age and mental health proximity significantly and uniquely predicted total mental health literacy (Age: β = -0.22, t = −2.04, p < 0.05; Proximity: β = 0.31, t = 2.78, p < 0.01). Older age predicted poorer PTSD mental health literacy (β = −0.31, t = −2.90, p < 0.01). ConclusionIn neurologically healthy older adults, level of executive function did not contribute to mental health literacy. Older adults in closer proximity to someone with a mental disorder were more likely to have better mental health literacy, a finding that has the potential to inform mental health education and promotion strategies in this population.

Health Literacy, Health Disparities, and Sources of Health Information in U.S. Older Adults.

Low health literacy in older adults has been associated with poor health outcomes (i.e., mortality, decreased physical and cognitive functioning, and less preventive care utilization). Many factors associated with low health literacy are also associated with health disparities. Interaction with healthcare providers and sources of health information are influenced by an individual's health literacy and can impact health outcomes. This study examined the relationships between health literacy, sources of health information, and demographic/background characteristics in older adults (aged 65 years and older) related to health literacy and disparities. This descriptive, correlational study is a secondary analysis of the 2003 National Assessment of Adult Literacy, a large-scale national assessment. Older adults with lower health literacy have less income and education, rate their health as poor or fair, have visual or auditory difficulties, need help filling out forms, reading newspaper, or writing notes, and use each source of health information less (print and nonprint). Many of these characteristics and skills are predictive of health literacy and associated with health disparities. The results expand our knowledge of characteristics associated with health literacy and sources of health information used by older adults. Interventions to improve health outcomes including health disparities can focus on recognizing and meeting the health literacy demands of older adults.

Effectiveness of the teach-back method for improving the health literacy of senior citizens in nursing homes.

To explore the effectiveness of the teach-back method for improving the health literacy of older adults in nursing homes in Ürümqi, the capital of Xinjiang, China. Among the 27 registered nursing homes, 10 were selected randomly by size and divided into the intervention and control groups. A total of 127 older adults in the intervention group and 136 in the control group met the inclusion criteria. The intervention and control groups were educated by using the teach-back and traditional methods, respectively, in this 6 month study. The Chinese Citizen Health Literacy Questionnaire was used to evaluate the effects of the interventions. Pre-intervention, the health literacy level of the cohorts was relatively low. Postintervention, the total health literacy score of the intervention group increased, while the total health literacy score of the control group had increased to a lesser extent. The total and four-dimension scores of the two groups were statistically significant. The intergroup difference in the two groups, and the intervention group's total health literacy score and each dimension score were higher than in the control group; these differences were statistically significant . The teach-back method can improve the health literacy level of older adults through short-term educational intervention. The teach-back method should be adopted by more healthcare providers and applied to improve the health literacy education of older adults.

Community-based initiatives improving critical health literacy: a systematic review and meta-synthesis of qualitative evidence

BackgroundCritical health literacy enables older adults to make informed health decisions and take actions for the health and wellbeing of themselves and their community, within their own social and cultural context. A community-based approach has the potential to improve the critical health literacy of older adults and their communities. However, it is not clear how such initiatives consider critical health literacy. Therefore, this study explored how community-based initiatives address the critical health literacy of older adults and their communities.MethodsA systematic literature search was conducted. Two reviewers independently screened titles and abstracts, as well as the quality of the methodological and community-based elements of the studies. In addition, a meta-synthesis was carried out, consisting of a qualitative text analysis of the results sections of the 23 included studies.ResultsWe identified two main themes, which are practices that contribute to the critical health literacy of older adults as well as their communities: 1) collaborative learning, and 2) social support. In these practices we identified reciprocity as a key characteristic of both co-learning and social support.ConclusionsThis study provides the first overview of community-based initiatives that implicitly address the critical health literacy of older adults and their community. Our results demonstrate that in the context of one’s own life collaborative learning and social support could contribute to people’s understanding and ability to judge, sift and use health information. We therefore suggest to add these two practices to the definition of critical health literacy.

The role of the nurse in improving health literacy among older adults

Abstract Introduction. The level of health literacy tells us how an individual functions within the healthcare system, how well he or she understands the instructions connected to health care, and how he or she looks after own health. However, at the same time, it can be an indicator of how healthy an individual is going to be in the future. In our research we wanted to establish the role of a nurse in improving health literacy among older adults. Method. The research was based on a quantitative research approach, using descriptive method. Data were collected with the interviewing technique. As a measuring instrument, a questionnaire formed on the basis of the review of domestic and foreign, professional and scientific literature, was used. We used a non-random purposive pattern, in which we included 148 older adults aged 65 years and above, who live in different residential environments and do not suffer from dementia. There were 140 correctly completed questionnaires, which represent a 94% realization of the sample. The data were analyzed by statistical program SPSS 22.0. Results. Older adults who took part in the research have achieved limited health literacy in the fields of general health literacy (AV=27.0), healthcare (AV=26.2), disease prevention (AV=28.8) and health promotion (AV=26.6). In the field of nurse counseling they achieved sufficient health literacy (AV=34.6). Discussion and conclusion. Health literacy is one of the factors that significantly affect the quality of life of older adults. We established that older adults who took part in the research have limited health literacy. The nurses can significantly contribute to improving the health literacy of older adults through health-educational work and health promotion. In the future, the role of the nurse in health promotion will have to become more prominent, particularly through their work in reference clinics and reference centers for health promotion.

Health Literacy in Older Adults and Its Related Factors: A Cross-Sectional Study in Southeast Iran

Background: Health literacy can influence physical activity, mortality, self-care behaviors and health outcome for some conditions and diseases especially among the aged population. Objectives: This study aimed to assess health literacy in older adults and its related factors to encourage and inform interventions and the future research outline concerning this group of population in Iran. Methods: This cross-sectional study was conducted on 200 older adults in southeast Iran, during year 2015. The twenty health centers were selected randomly and 10 subjects were selected using multistage random sampling from a population from each health center. The Test of Functional Health Literacy in Adults Questionnaire was used for collecting the data. The data was analyzed using the Stata.12 software using Independent T test, Chi-square test and multiple linear regression. Results: The mean age of the subjects was 62.1 ± 3.9 years (ranging from 55 to 75 years old). The total mean score of health literacy was 64.4 ± 18.4 (range: 12 to 97). The mean score of health literacy amongst males and females was 61.5 ± 19.9 (range: 12 - 96) and 67.1 ± 16.6 (range: 22 - 97), respectively (P = 0.032). About 38.5% (n = 77), 29% (n = 58) and 32.5% (n = 65) of the subjects had inadequate, borderline and adequate HL level, respectively. Bivariate analysis and the results of linear regression analysis demonstrated that monthly income (β = 6.25, 95% CI: 5.03 - 17.27), educational level (β=6.61, 95% CI: 1.78-10.3) and husband’s educational level (β = 5.11, 95% CI: 3.2 - 11.21) were significantly associated with health literacy scores level of older adults. Conclusions: The results of this study showed that generally health literacy level is low among older adults in southeast Iran and needs special attention. The level of education was the most important determinant of health literacy. It seems that the best way to increase health literacy among older adults is health literacy training programs that should be implemented with respect to educational level, gender and income of the individuals.

Health Literacy in Older Adults With and Without Low Vision.

In this study, we investigated whether older adults with low vision (LV) from age-related macular degeneration (AMD) demonstrated lower functional health literacy than older adults without LV. Fifty adults with AMD were matched with adults without LV on age, gender, education, and income. We measured visual acuity, contrast sensitivity, and reading speed and administered the Test of Functional Health Literacy in Adults (TOFHLA) using two test time conditions, standard and unlimited, to measure health literacy levels. The group with LV had considerably lower TOFHLA scores for both time conditions (p < .001) and took notably longer to complete the test (p < .001). Poorer acuity correlated with lower TOFHLA scores in the group with LV. Older adults with LV may take longer to read and understand health information, which has important implications for providing health education to support self-management. Modifying components of the reading task may facilitate reading performance and understanding of health education materials.

Cognition and Health Literacy in Older Adults' Recall of Self-Care Information.

Health literacy is associated with health outcomes presumably because it influences the understanding of information needed for self-care. However, little is known about the language comprehension mechanisms that underpin health literacy. We explored the relationship between a commonly used measure of health literacy (Short Test of Functional Health Literacy in Adults [STOFHLA]) and comprehension of health information among 145 older adults. Results showed that performance on the STOFHLA was associated with recall of health information. Consistent with the Process-Knowledge Model of Health Literacy, mediation analysis showed that both processing capacity and knowledge mediated the association between health literacy and recall of health information. In addition, knowledge moderated the effects of processing capacity limits, such that processing capacity was less likely to be associated with recall for older adults with higher levels of knowledge. These findings suggest that knowledge contributes to health literacy and can compensate for deficits in processing capacity to support comprehension of health information among older adults. The implications of these findings for improving patient education materials for older adults with inadequate health literacy are discussed.

The role of cognitive function in the relationship between age and health literacy: a cross-sectional analysis of older adults in Chicago, USA

ObjectivesTo investigate how 3 measures of health literacy correlate with age and the explanatory roles of fluid and crystallised cognitive abilities in these relationships among older adults.DesignCross-sectional baseline analysis of...

Aging and Functional Health Literacy: A Systematic Review and Meta-Analysis.

Objectives:To review the evidence on the association between age and limited health literacy, overall and by health literacy test, and to investigate the mediating role of cognitive function.Method:The Embase, MEDLINE, and PsycINFO databases were searched. Eligible studies were conducted in any country or language, included participants aged ≥50 years, presented a measure of association between age and health literacy, and were published through September 2013.Results:Seventy analyses in 60 studies were included in the systematic review; 29 of these were included in the meta-analysis. Older age was strongly associated with limited health literacy in analyses that measured health literacy as reading comprehension, reasoning, and numeracy skills (random-effects odds ratio [OR] = 4.20; 95% confidence interval [CI]: 3.13–5.64). By contrast, older age was weakly associated with limited health literacy in studies that measured health literacy as medical vocabulary (random-effects OR = 1.19; 95% CI: 1.03–1.37). Evidence on the mediating role of cognitive function was limited.Discussion:Health literacy tests that utilize a range of fluid cognitive abilities and mirror everyday health tasks frequently observe skill limitations among older adults. Vocabulary-based health literacy skills appear more stable with age. Researchers should select measurement tests wisely when assessing health literacy of older adults.

Aging and Health Literacy

A recent study comparing older adults’ health literacy skills with their satisfaction with health care providers’ communication efforts did not find a correlation between the two measures. However, the results were interesting, including the fact that almost 40 percent of participants experienced moderate to severe difficulties in understanding everyday health information as presented in a food label (Newest Vital Sign assessment). This has implications for senior patient engagement in health care, particularly at a time when so many health transactions such as scheduling and records requests, not to mention general health information, are moving to online only format. Librarians should be aware of the issues surrounding health literacy in older adults and work with providers to address those deficits in health care navigation in this population.

Cognitive function is a risk for health literacy in older adults with diabetes

AimsCognitive impairment is common in older adults with diabetes, yet it is unclear to what extent cognitive function is associated with health literacy. We hypothesized that cognitive function, independent of education, is associated with health literacy. MethodsThe sample included 537 African American, American Indian, and White men and women 60 years or older. Measures of cognitive function included the Mini-Mental State Examination (MMSE), Verbal Fluency, Brief Attention, and Digit Span Backward tests. Health literacy was assessed using the S-TOFHLA. ResultsCognitive function was associated with health literacy, independent of education and other important confounders. Every unit increase in the MMSE, Digit Span Backward, Verbal Fluency or Brief Attention was associated with a 20% (p<.001), 34% (p<.001), 5% (p<.01), and 16% (p<.01) increase in the odds of having adequate health literacy, respectively. ConclusionsThese results suggest that cognitive function is associated with health literacy in older adults with diabetes. Because poor cognitive function may undermine health literacy, efforts to target older adults on improving health literacy should consider cognitive function as a risk factor.

Promoting Health Literacy in Older Adults With Low Vision

Promoting Health Literacy in Older Adults With Low Vision

Systematic Review of Consistency between Adherence to Cardiovascular or Diabetes Medication and Health Literacy in Older Adults

To review the relationship between health literacy and adherence to cardiovascular/diabetes medication. We searched EMBASE (1974-February 2012) and MEDLINE (1948-February 2012). Search terms included health literacy, numeracy, health education and related terms, health literacy measurement tools, and medication adherence. English-language articles of all study designs were considered. Articles were included if they had a measurement of health literacy and medication adherence and if participants were older adults taking drugs for cardiovascular illness or diabetes mellitus. A total of 1310 citations were reviewed, including 9 articles that reported on 7 research studies. Most studies were retrospective, and all were based in the US. Because there was considerable diversity in measurements, participant characteristics, and outcome measures, we conducted a narrative synthesis rather than a meta-analysis. In assessing study validity, we looked at participant selection, method of measuring health literacy and medication adherence, missing data or losses, and adjustment for confounders. Of the 7 included studies, only 1 found a demonstrable association between health literacy and refill adherence. One clinical trial failed to show significant improvements in medication adherence after an intervention to improve health literacy. The current evidence does not show a definite association between health literacy and medication adherence in older adults with cardiovascular disease or diabetes mellitus. In the absence of a definite link, efforts to develop interventions to improve health literacy would not necessarily improve adherence to cardiovascular medications. There is an urgent need for robust studies outside of the US, with wider, generalized recruitment of participants.

Performance of Health Literacy Tests Among Older Adults with Diabetes

Knowing a patient's health literacy can help clinicians and researchers anticipate a patient's ability to understand complex health regimens and deliver better patient-centered instructions and information. Poor health literacy has been linked with lower ability to function adequately in health care systems. We evaluated and compared three measures of health literacy and performance among older patients with diabetes. Cross-sectional study utilizing in-person interviews conducted in participants' homes. A tri-ethnic sample (n = 563) of African American, American Indian, and white older adults with diabetes from eight counties in south-central North Carolina. Participants completed interviews and health literacy assessments using the Short-Form Test of Functional Health Literacy in Adults (S-TOFHLA), the Rapid Estimates of Adult Literacy in Medicine Short-Form (REALM-SF), or the Newest Vital Signs (NVS). Scores for reading comprehension and numeracy were calculated. Over 90% completed the S-TOFHLA numeracy and approximately 85% completed the S-TOFHLA reading and REALM-SF. Only 73% completed the NVS. The correlation of S-TOFHLA total scores with REALM-SF and NVS were 0.48 and 0.54, respectively. Age, gender, ethnic, educational and income differences in health literacy emerged for several instruments, but the pattern of results across the instruments was highly variable. A large segment of older adults is unable to complete short-form assessments of health literacy. Among those who were able to complete assessments, the REALM-SF and NVS performed comparably, but their relatively low convergence with the S-TOFHLA raises questions about instrument selection when studying health literacy of older adults.

Assessing Health Literacy in Heart Failure Patients

Background Health literacy has important implications for health interventions and clinical outcomes. The Shortened Test of Functional Health Literacy in Adults (S-TOFHLA) is a timed test used to assess health literacy in many clinical populations. However, its usefulness in heart failure (HF) patients, many of whom are elderly with compromised cognitive function, is unknown. We investigated the relationship between the S-TOFHLA total score at the recommended 7-minute limit and with no time limit (NTL). Methods and Results We enrolled 612 rural-dwelling adults with HF (mean age 66.0 ± 13.0 years, 58.8% male). Characteristics affecting health literacy were identified by multiple regression. Percentage of correct scores improved from 71% to 86% (mean percent change 15.1 ± 18.1%) between the 7-minute and NTL scores. Twenty-seven percent of patients improved ≥1 literacy level with NTL scores ( P < .001). Demographic variables explained 24.2% and 11.1% of the variance in % correct scores in the 7-minute and the NTL scores, respectively. Female gender, younger age, higher education, and higher income were related to higher scores. Conclusion Patients with HF may be inaccurately categorized as having low or marginal health literacy when the S-TOFHLA time limits are enforced. New ways to assess health literacy in older adults are needed.

More than Words: Promoting Health Literacy in Older Adults

Inadequate health literacy disproportionately affects older adults in the United States. The complexities associated with managing chronic disease and the cognitive and sensory changes associated with aging compound the challenges of teaching this highly vulnerable group. In order to enhance comprehension and bring about positive health behavior changes, the nurse must use more than words when teaching an older adult. Multiple teaching strategies that are tailored to accommodate the cognitive, physical, and psychological changes associated with aging, such as clear communication that is purposeful and individualized and a patient-centered approach that demonstrates acceptance and respect, are actions that the nurse must take to promote health literacy in the older adult. This article describes the effect of age-related changes on health literacy, addresses the challenges inherent in communicating with and teaching older adults, and suggests age-appropriate teaching strategies that the nurse can implement to improve the health literacy of an aging patient. Suggestions for evaluating comprehension are also provided.

Health Literacy and Cognitive Performance in Older Adults

To study the relationship between health literacy and memory and verbal fluency in older adults. Cross-sectional cohort. Twenty senior centers and apartment buildings in New York, New York. Independently living, English- and Spanish-speaking adults aged 60 and older (N=414). Health literacy was measured using the Short Test of Functional Health Literacy in Adults (S-TOFHLA). The associations between S-TOFHLA scores and immediate and delayed recall (Wechsler Memory Scale II), verbal fluency (Animal Naming), and global cognitive function (Mini-Mental State Examination, MMSE) were modeled using multivariable logistic and linear regression. Health literacy was inadequate in 24.3% of participants. Impairment of immediate recall occurred in 20.4%; delayed recall, 15.0%; verbal fluency, 9.9%; and MMSE, 17.4%. Abnormal cognitive function was strongly associated with inadequate health literacy: immediate recall (adjusted odds ratio (AOR)=3.44, 95% confidence interval (CI)=1.71-6.94, P<.001), delayed recall (AOR=3.48, 95% CI=1.58-7.67, P=.002), and verbal fluency (AOR=3.47, 95% CI=1.44-8.38, P=.006). These associations persisted in subgroups that excluded individuals with normal age-adjusted MMSE scores. Memory and verbal fluency are strongly associated with health literacy, independently of education and health status, even in those with subtle cognitive dysfunction. Reducing the cognitive burden of health information might mitigate the detrimental effects of limited health literacy in older adults. Research that examines the effect of materials modified to older adults' cognitive limitations on health literacy and health outcomes is needed.

An Investigation of the Relationship Between Health Literacy and Social Communication Skills in Older Adults

The purpose of this study was to examine connections between health literacy and social communication skills in older adults, a population that experiences chronic health conditions but is reported to have low health literacy and declines in communication skills. Sixty-three older adults were administered the Social Communication subtest of the Functional Assessment of Communication Skills in Adults and the Short Test of Functional Health Literacy in Adults. Correlational statistics indicated significant relationships between social communication skills and health literacy in older adults. Aspects of social communication that involve initiating discourse, facial expressions, and voice tone were positively related to reading comprehension items that involve informing, naming, and requesting information. Results of the study suggest that social communication skills may possibly serve as predictors of health literacy. Further study of the potential relationships between these variables is needed to improve health literacy assessment and intervention for older adults.