Health Literacy In Older Adults Research Articles

Health Literacy and Health-Related Quality of Life in Older Adults with Mild Cognitive Impairment

ObjectivesHealth literacy is considered crucial in health status outcomes, but little is known about the association among cognitively impaired persons. This study investigated the association between health literacy and health-related quality of life (HRQoL) in older adults with mild cognitive impairment (MCI). We further examined whether the association between health literacy and HRQoL depends on age, sex, and educational attainment. DesignA cross-sectional study was conducted between January and December 2022. Setting and ParticipantsThe study population was 233 older adults with MCI who visited the Veterans Health Service Medical Center in Seoul, Republic of Korea. MethodsThe diagnosis of MCI was confirmed by a physician based on clinical and neuropsychological assessments. The European Health Literacy Survey Questionnaire and EuroQol Five Dimensions Questionnaire were used to measure the health literacy and HRQoL of the participants. ResultsHRQoL was significantly correlated with health literacy (R = 0.25, P ≤ .001) and its 3 subdomains (R = 0.27, P ≤ .001 for healthcare; R = 0.19, P = .004 for disease prevention; and R = 0.18, P = .005 for health promotion). After adjustment for potential covariates, older adults with higher levels of health literacy were significantly associated with better HRQoL: β = 0.02 (P = .0021) for health literacy, β = 0.07 (P = .0001) for healthcare, and β = 0.04 (P = .0443) for disease prevention. The interactions between HRQoL and health literacy with the specific variables of age, sex, and education demonstrated a statistical significance (β = 0.02 with age, β = 0.03 with sex, and β = 0.06 with education). Conclusions and ImplicationsThere was a significant association between health literacy and HRQoL among older adults with MCI. This finding suggests that improving health literacy of older adults with MCI may enhance HRQoL. An education intervention is recommended to reduce the existing health disparities due to low health literacy.

Association of age, education, and cognition with digital health literacy in older adults

Association of age, education, and cognition with digital health literacy in older adults

Qualitative Evaluation of a Health Literacy Program for Older Adults Who Live in a Community Dwelling in Brazil.

To address current gaps in health literacy research and practice in low-resource settings, the 'Alfa-Health Program' was designed to improve health literacy in older adults who live in a community dwelling in a socioeconomically disadvantaged community in North-East Brazil. In this longitudinal qualitative study, participants were interviewed before and after participating in the group-based program that was delivered November 2017 to December 2017 in the Primary Care Health Unit. Semi-structured interviews were guided by a previously validated health literacy instrument, translated and adapted for use in Brazil. Data was analyzed using Framework analysis. Of the 21 participants, the majority were age 60 to 69 years with a median of 4-years of school education. Our analysis identified self-reported improvements in health knowledge, behaviors, and skills that matched program content and indicated that participants were supported to manage their health conditions more autonomously. Other themes reflect the distributed nature of health literacy and the potential for group-based health literacy programs to facilitate feelings of social support and cohesion through co-learning. However, age-related deficits in memory and external and structural factors remained important barriers to program participation. This study provides insight into developing health literacy in low-resource settings with older adults, where health literacy is compounded by social determinants and cognitive and sensory changes that contribute to health disparities. Although the targeted Alfa Health Program addresses calls to ensure that priority is proportionate to need by reaching and engaging population groups who are disproportionately affected by low health literacy, further work is needed to adapt the program for people who are unable to read or write. [HLRP: Health Literacy Research and Practice. 2024;8(3):e140-e150.].

Factors Predicting Mental Health Literacy in Older Adults: A Community-Based Cross-Sectional Study.

To determine mental health literacy (MHL) levels of older adults and the predictive factors of MHL. This cross-sectional study was conducted between October and December 2022, with 410 older adults aged ≥65 years. A Personal Information Form and the Mental Health Literacy Scale were used for data collection. Independent samples t test, analysis of variance, and multiple linear regression were used to analyze the data. Significant predictors of MHL in older adults were being aged 65 to 69 years, being female, being a university graduate, having an income more than expenses, receiving information from a health professional, interest in mental health, having friends or family members with mental illness, and good perception of health. Older adults were found to have low levels of MHL. Mental health professionals should focus on community-based education and interventions to increase the MHL levels of older adults. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

A Nomogram for Predicting the Infectious Disease-specific Health Literacy of Older Adults in China

To identify the predictors of infectious disease-specific health literacy (IDSHL), and establish an easy-to-apply nomogram to predict the IDSHL of older adults. This cross-sectional study included 380 older adults who completed the IDSHL, self-rated health, socio-demographic and other questionnaires. Logistic regression was used to identify the IDSHL predictors. Nomogram was used to construct a predictive model. Up to 70.1% of older adults had limited IDSHL. Age, education, place of residence, self-rated health, and Internet access were the important influencing factors of IDSHL. The established nomogram model showed high accuracy (receiver operating characteristic curve: 0.848). The IDSHL of Chinese older adults was significantly deficient. The constructed nomogram is an intuitive tool for IDSHL prediction that can not only contribute towardrapid screening of high-risk older adults with limited IDSHL but also provide guidance for healthcare providers to develop prevention strategies for infectious diseases.

Health literacy in older adults: The newest vital sign and its relation to cognition and healthy lifestyle behaviors

Health literacy tends to decrease with age, and lower health literacy has been associated with lower levels of physical function, mental health, and medication adherence. The present study examined health literacy in relation to cognition in a sample of community-dwelling older adults. The study also examined the impact of health literacy on engagement in healthy aging lifestyle behaviors. Participants included 128 older adults (age: M = 72.07, SD = 6.71; education: M = 16.34, SD = 2.56; 74% female) who completed a health literacy measure (Newest Vital Sign; NVS), a lifestyle behavior questionnaire (Healthy Aging Activity Engagement scale; HAAE), and several neuropsychological tests. The cognitive domains assessed included memory, executive function, and attention/working memory. Two variables were computed from the NVS to represent the health literacy factors of document and numeracy literacy; these factors demonstrated a small correlation (r = .18). Results revealed that attention/working memory, executive function, and memory were all significantly related to numeracy literacy and overall health literacy. Only memory was significantly related to document literacy. After accounting for age, education, and cognition, a hierarchical regression revealed that health literacy significantly predicted engagement in healthy aging lifestyle behaviors. Multiple cognitive abilities are necessary for searching, finding, and processing information to make health-related decisions. Health literacy accounted for a significant amount of variance in older adults’ engagement in everyday lifestyle behaviors. Health literacy skills may be an area of focus for intervention efforts to improve brain health in older adults.

Psychometric Testing of HeLD-14 in a Colombian Geriatric Population.

The objective of this study was to test the validity and reliability of the Colombian version of the Health Literacy in Dentistry (HeLD-14) in older adults. A translation and validation study of HeLD-14 was conducted on 384 non-institutionalized older adults attending the Dental Clinic at Universidad Cooperativa from Pasto, Colombia. A cross-cultural adaptation of a multidimensional HeLD-14 was completed, and the psychometric properties of this scale were evaluated through a cross-validation method using an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA). Internal consistency was measured with Cronbach's alpha (α) and Omega's McDonald (ɷ). The statistical significance was set at P < 0.05. The EFA demonstrated that a single-factor structure with 11 items explained a cumulative 59.86% of the overall variance. The CFA confirmed that goodness of fit indices of this questionnaire had optimal adequateness (χ2S-B = 109.047; χ2S-B/(44) = 2.478, P=0.001; non-normed fit index = 0.901; comparative fit index = 0.908; root mean square error of approximation = 0.079 (90% CI (0.075, 0.083)); standardized root mean residual = 0.080). The coefficients indicated a high internal consistency for the total scale (α = 0.94; ɷ = 0.96). The developed adaptation of HeLD-14 for the Colombian population, HeLD-Col, is a unidimensional, reliable, and valid instrument to assess oral health literacy in older adults in Colombia.

Health literacy in older adults receiving hemodialysis in Turkey: A cross-sectional study.

This study aimed to determine the health literacy level and related factors of older adults receiving hemodialysis treatment. A cross-sectional study was conducted at the five dialysis centers, using the information form and Turkish Health Literacy Survey-32 (THLS-32). A total of 336 older adults receiving hemodialysis treatment participated. The general health literacy score was found to be 25.69 ± 14.47. Based on the health literacy assessment scores, 62.5% of the participants were in the category of inadequate and limited level of health literacy. The lower level of education, perceived health status, income, and getting help in reading and writing were statistically significant predictors of the health literacy score. The health literacy of older adults receiving hemodialysis treatment was inadequate and limited. Findings of this study emphasize the importance of integrating health literacy assessment in clinical care settings and supporting the health literacy of older adults receiving hemodialysis treatment.

Digital social media expression and social adaptability of the older adult driven by artificial intelligence.

This study examines the impact of digital new media art on the health literacy and digital health literacy of older adults. It explores how digital new media art influences the social adaptability of the older adult, with a focus on variations in their engagement with digital technologies and community activities. The research employed interviews and observations of older adult participants from communities A and B. Data were collected on their smartphone usage, community engagement, and access to technological infrastructure. The study also assessed their interaction with digital new media across various domains, including interpersonal communication, information retrieval, entertainment, practical applications, and mobile payments. The study found significant differences in engagement with digital new media art among the older adult. Participants with prior computer experience were generally more skilled in using smartphones and more active in community events. In contrast, individuals in community B showed lower acceptance of digital new media art and no clear association with community participation. There was substantial variability in their use of digital media for information retrieval, entertainment, practical applications, and mobile payments. Some older adult individuals demonstrated proficiency with these technologies, while others were more reserved. The findings suggest that digital new media art can enhance community participation and social adaptability among older adults, particularly those with prior computer experience. However, disparities in digital media usage highlight the need for targeted interventions to improve digital health literacy and engagement across different community settings. The study underscores the importance of addressing these disparities to ensure that all older adults can benefit from digital advancements, thereby improving their overall well-being and health literacy.

Using ‘Health’ to Promote Older Adults’ Digital Health Literacy

Aim: This project explored requirements for digital learning to support digital health literacy of older adults within a rural region. Method: A qualitative study with purposeful sampling and thematic analysis of data. Interviews were held with ten digital educators and seven older adults (four with low vision) living and/or working in rural New Zealand. Results: All participants recognised the importance of trust and having the right people to provide support and foster positive engagement with digital technologies. The digital educators recognised a missed opportunity to engage older adults using health as a topic for digital learning. Conclusion: A positive experience with learning to use digital technologies is necessary to facilitate digital health literacy for older adults. Digital educators want access to reputable resources to promote health websites; many don’t know these exist. A wide range of digital literacy learning services exist which need to be better promoted in hard copy and online. The authors recommend building on older adults’ existing relationships, engaging with community groups, providing pop-up sessions, and running events to increase digital technological knowledge and engage with health information online. The key is utilising the right people to support the older adult with opportunities for digital skills uptake.

Factors associated with poor health literacy in older adults: A systematic review

ObjectivesTo identify factors associated with poor health literacy in older adults. MethodsA systematic literature review was conducted, employing the descriptors “Aged” and “Health Literacy”. PROSPERO - CRD: 42022350140. ResultsOut of 23,500 articles screened, 176 were selected. Several factors associated with poor health literacy in older adults were identified, such as sociodemographic (e.g., advanced age, low educational level, non-white population, and others), social (e.g., poor family/social support, loneliness, social isolation, few social activities, and others), economic (e.g., lower income and/or lower socioeconomic status) and health aspects (e.g., poor health, chronic conditions, mental health challenges, hospitalizations, frailty, physical inactivity, cognitive impairment, and others). ConclusionsThe factors associated with poor health literacy in older adults identified in this review could contribute to future research, support interventions to improve health literacy, and assist professionals in planning educational activities and public policies.

Successful Aging is Associated with Better Health Literacy in Older Adults with HIV Disease.

People with HIV (PWH) are susceptible to neurocognitive, physical, and mental health problems that may decrease their likelihood of experiencing successful aging. This cross-sectional, retrospective study estimated the extent to which health literacy is associated with successful aging among 116 older PWH and 60 persons without HIV. Successful aging was defined using indicators of biological health, cognitive efficiency, mental health, and productivity. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine, Newest Vital Sign, Brief Health Literacy Screening, and Beliefs Related to Medication Adherence. A series of logistic regressions covarying for education showed that better health literacy was associated with a higher frequency of successful aging among older PWH. Older PWH were approximately three times less likely to experience successful aging as compared to older adults without HIV. Future studies may examine whether improving health literacy among younger PWH increases the likelihood of successful aging.

Analysis of factors influencing health literacy of older adults by applying the Anderson model

ABSTRACT This study attempted to identify the level of health literacy among older adults by applying the Andersen model and analyzing the factors affecting this level. We used the nationwide secondary data from the 2021 Korea Community Health Survey. Data obtained from 74,492 older adults aged 65 years or more were analyzed using the t-test, Pearson’s correlation coefficient, and multiple regression analysis. As a result of applying the Anderson model to the health literacy ability of older adults, statistically significant variables were predisposing (age, sex, spouse), enabling (education level), and need (subjective health status) factors for health literacy. Based on the results of this study, we conclude that it is necessary to establish a public healthcare program to improve the health literacy and welfare of older adults.

Impact of digital health literacy on health-related quality of life in Chinese community-dwelling older adults: the mediating effect of health-promoting lifestyle.

In the context of aging and digitalization, the development and application of digital health can help meet the growing health needs of older adults. Improving digital health literacy of older adults may be an effective way to alleviate the shortage of public health resources and improve their health-related quality of life (HRQoL). However, the impact of digital health literacy on HRQoL in older adults and the underlying mechanism remain unclear. This study intends to explore whether digital health literacy has an effect on HRQoL in community-dwelling older adults, and whether health-promoting lifestyle plays a mediating role between digital health literacy and HRQoL, while providing a theoretical basis for the scientific construction of HRQoL intervention programs for older adults. The cross-sectional study was conducted in Chongqing, China from September 2020 to April 2021. 572 community-dwelling older adults were surveyed by stratified sampling. Data on sociodemographic characteristics, digital health literacy, health-promoting lifestyle and HRQoL were collected. Univariate analysis was used to compare the differences in HRQoL among community-dwelling older adults with different sociodemographic characteristics. Pearson correlation analysis was used to explore the correlation between digital health literacy, health-promoting lifestyle and HRQoL. SPSS PROCESS macro was used to examine the mediating effect of health-promoting lifestyle between digital health literacy and HRQoL. The mean score of HRQoL was 97.97 (SD 11.45). Univariate analysis showed that there were statistically significant differences in HRQoL among community-dwelling older adults with different gender, age, educational level, marital status, and monthly household income per capita (p < 0.05). There were positive correlations between digital health literacy, health-promoting lifestyle and HRQoL, with correlation coefficients ranging from 0.416 to 0.706 (p < 0.001). Digital health literacy was positively associated with HRQoL (β = 0.210, p < 0.001), and health-promoting lifestyle mediated the relationship between digital health literacy and HRQoL, with an indirect effect of 0.175 (95% Bootstrap CI 0.135-0.214). Digital health literacy can affect HRQoL through the mediating effect of health-promoting lifestyle. It is suggested that relevant management institutions, communities and families should strengthen the cultivation of the digital health literacy of older adults, promote their development of health-promoting lifestyle, and ultimately improve HRQoL.

Prevalence of health literacy and its correlates from a national survey of older adults

Health literacy (HL) is an important determinant of health. Sub-optimal HL can have profound consequences for individuals and health systems. However, little is known about the HL of older Singaporeans. This study determined the prevalence, socio-demographic and health-related correlates of limited and marginal HL among older Singaporeans (≥65 years). Data from a national survey were analysed (n=2327). HL was measured using the 4-item BRIEF with a 5-point response scale (range 4-20), and classified as limited, marginal, and adequate. Multinomial logistic regression models were applied to identify correlates of limited and marginal HL versus adequate HL. The weighted prevalence of limited HL was 42.0%, marginal HL was 20.4% and adequate HL was 37.7%. In adjusted regression analysis, older adults in advanced age groups with lower education and those living in 1-3 room flats had higher risk of limited HL. Furthermore, having ≥3 chronic diseases (Relative Risk Ratio [RRR]=1.70, 95% Confidence Interval [95% CI]=1.15, 2.52), poor self-rated health (RRR=2.07, 95% CI=1.56, 2.77), vision impairment (RRR=2.08, 95% CI=1.55, 2.80), hearing impairment (RRR=1.57, 95% CI=1.15, 2.14) and mild cognitive impairment (RRR=4.87, 95% CI=2.12, 11.19) were also associated with limited HL. The likelihood of marginal HL was higher among those with lower education, ≥2 chronic diseases, poor self-rated health (RRR=1.48, 95% CI=1.09, 2.00), vision impairment (RRR=1.45, 95% CI=1.06, 1.99) and hearing impairment (RRR=1.50, 95% CI=1.08, 2.08). Over two-thirds of older adults faced difficulties in reading, understanding, exchanging, and using health information and resources. There is a pressing need to create awareness about the issues that could result from the mismatch between healthcare system demands and the HL of older adults.

Evaluation of the Japanese version of HLS-Q12 in older adults

Objectives The purpose of this study was to evaluate the internal consistency and factorial validity of the Japanese version of HLS-Q12 health literacy rating scale when used with older adults.Methods A questionnaire-based mail survey was conducted among older adults living in a community. The data collection period was from January to February 2022. The Japanese version of HLS-Q12 was used to obtain data on health literacy of older adults, and the internal consistency and factorial validity of the scale were evaluated using Cronbach's alpha coefficient and confirmatory factor analysis, respectively. In addition, a Rasch model was used to conduct a detailed analysis on each questionnaire item.Results Questionnaires were distributed among 3,572 people, out of which, 1,082 responses were received from older adults (over 65 years of age). Cronbach's alpha coefficient was 0.8 or higher, indicating no internal consistency issues. According to the confirmatory factor analysis, CFI was equal to 0.933, AGFI, 0.876, and RMSEA, 0.092; thus, all indicators met certain evaluation levels. However, deviation from one of the multiple fit criteria was confirmed for the value of RMSEA, indicating that the error between the estimated value calculated by the scale and the true value was relatively large. Analysis of each question item using the Rasch model showed that all the questions met the criteria of Infit MSQ and were suitable in their question structure.Conclusion Following the evaluation of the HLS-Q12 scale in older adults, the scale was found to be reliable and valid at a certain level. However, the value of RMSEA indicated that it was relatively large in terms of the error between the estimated value calculated by the scale and the true value.

Providing Health-Literacy-Level-Appropriate Health Education to Older Adults in the Post-Pandemic Era

The rapidly changing and high-risk nature of communicable diseases for older adults require individuals in this age group to appropriately change their lifestyle and healthcare habits and engage in self-care more actively and seriously. Good self-health management relies on good health literacy in order to be able to read, understand, and apply relevant health information; to communicate clearly with healthcare providers; and to take health-related decisions and actions. The results of research indicate the health literacy of over 50% of older adults in Taiwan to be inadequate, which may be expected to negatively impact on related health outcomes. After introducing the content, determinants, and impacts of health literacy, the author suggests strategies to improve health literacy in older adults in five activity domains based on current theories and research findings. These domains include: formulate public policies for health literacy, adjust the orientation of health services, construct a friendly healthy information environment for health literacy, strengthen community health literacy education resources, and promote gerontological education and shared decision-making in health care.

The Relationship between Successful Aging and Health Literacy in Older Adults

Purpose. This study aims to determine the relationship between successful aging and health literacy in older adults. Design and Methods. This cross-sectional, descriptive, and correlational study was conducted between April and September 2021. The sample of the study comprised 379 voluntary older adults aged 65 and above who visited a health center. A descriptive information form, the adult health literacy scale, and the successful aging scale were used for data collection. Results. The levels of health literacy were low, whereas the perceptions of successful aging were high. Besides, compared to female participants, the levels of health literacy and the perceptions of successful aging were higher in male participants. Age was negatively correlated with the level of health literacy. Furthermore, health literacy levels and successful aging perceptions of married participants were high. Finally, as the education levels increased, so did the health literacy level and successful aging perceptions. Practice Implications. Health policies to promote successful aging and health literacy in adults may be developed. Besides, intervention plans to improve the health literacy levels of different age groups may be prepared. Further studies that use culture-specific scales may be conducted.

Association between multiple chronic conditions and insufficient health literacy: cross-sectional evidence from a population-based sample of older adults living in Switzerland

BackgroundHealth literacy is the ability to find, understand, assess, and apply health information. Individuals suffering from multiple chronic conditions have complex healthcare needs that may challenge their health literacy skills. This study aimed to investigate the relationship between multimorbidity, the number of chronic conditions, and health literacy levels in a sample of adults aged 58+ in Switzerland.MethodsWe used data from 1,615 respondents to a paper-and-pencil questionnaire administered as part of wave 8 (2019/2020) of the Survey of Health, Ageing and Retirement in Europe (SHARE) in Switzerland. Health literacy was measured using the short version of the European Health Literacy Survey questionnaire. The final score ranged from 0 to 16 and was categorised into three health literacy levels: inadequate (0–8), problematic (9–12), and sufficient (13–16). The number of chronic conditions was self-reported based on a pre-defined list. Associations were examined using multivariable ordinary least squares and ordered probit regression models, controlling for key socio-demographic characteristics.ResultsOverall, 63.5% of respondents reported having at least one chronic condition. Respondents who reported one, two, and three or more chronic conditions were more likely to have lower health literacy scores compared to respondents who did not report any chronic condition (p<0.05, p<0.01, and p<0.001, respectively). Suffering from two and three or more chronic conditions (vs. no chronic condition) was significantly associated with a higher likelihood of having inadequate or problematic health literacy levels (both p-values <0.01).ConclusionsOur findings suggest a need to improve health literacy in older adults suffering from chronic conditions. Improved health literacy could constitute a promising lever to empower individuals to better self-manage their health to ultimately reduce the double burden of chronic diseases and insufficient health literacy in this vulnerable population.

Oral Health Literacy and Health Seeking Behavior of Older Adults in Rural Community

Objectives: This community-based cross-sectional study aimed to examine health information seeking behavior regarding oral health and oral health literacy and their relationship in older adults. Methods: The research was conducted with 432 participants from the rural area of, Noen Maprang District, Phitsanulok province, Northern Thailand. To measure oral health literacy, modified Short Test of Functional Health Literacy in Dentistry for Older Adults was used. The adapted questionnaire was used to collect health information seeking behavior in the past 3 months. Results: Only 12.3% demonstrated adequate oral health literacy. Some 27.1% presented active health information seeking behavior, 57.3% presented passive health information seeking behavior and 15.6% had never obtained or sought any oral health information. The association between health information seeking behavior and oral health literacy could not be observed. Television, health personnel, family members/relatives and village health volunteers were the most popular information sources. Conclusions: By adding oral health information and improving skills of oral health information for village health volunteers, it is possible to develop oral health literacy in older adults in rural areas.