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Li H, Zheng Y, Li Q, Wang M. Cognitive Function, Healthy Lifestyle, and All-Cause Mortality among Chinese Older Adults: A Longitudinal Prospective Study. Nutrients 2024; 16:1297. [PMID: 38732544 PMCID: PMC11085585 DOI: 10.3390/nu16091297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Both cognitive decline and unhealthy lifestyles have been linked to an elevated risk of mortality in older people. We aimed to investigate whether a healthy lifestyle might modify the association between cognitive function and all-cause mortality in Chinese older populations. METHODS The final analysis included 5124 individuals free of dementia, selected from the Chinese Longitudinal Healthy Longevity Survey from 2011 to 2018. Cognitive function was assessed in 2011 using the Mini-Mental State Examination (MMSE). A lifestyle score was calculated based on five lifestyle factors, including smoking, alcohol consumption, physical activity, diet, and body mass index. Cox proportional hazards models were performed to evaluate the association between baseline cognitive function and the risk of all-cause mortality, with an interaction term of cognitive function and lifestyle score being added to the models. RESULTS The average age of participants was 81.87 years old at baseline. During a median follow-up of 6.4 years, 1461 deaths were documented. Both higher cognitive function (HR: 0.96; 95% CI: 0.96-0.97) and a healthier lifestyle (HR: 0.92; 95% CI: 0.87-0.97) were significantly associated with a reduced risk of mortality. We found that lifestyle significantly modified the association of cognitive function with mortality (p for interaction = 0.004). The inverse relation between cognitive function and mortality was found to be more pronounced among participants with a healthier lifestyle. Of note, among the lifestyle scores component, diet showed a significant interaction with mortality (p for interaction = 0.003), and the protective HR of the all-cause mortality associated with higher MMSE scores was more prominent among participants with healthy diets compared with unhealthy diets. CONCLUSIONS Our study indicates that cognitive decline is associated with a higher risk of mortality, and such associations are attenuated by maintaining a healthy lifestyle, with a particular emphasis on healthy diet.
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Affiliation(s)
- Huiwen Li
- China Population and Development Research Center, Beijing 100081, China;
| | - Yi Zheng
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China
| | - Qi Li
- Institute of Social Development, Chinese Academy of Macroeconomic Research, Beijing 100038, China;
| | - Mengying Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China
- Key Laboratory of Epidemiology of Major Diseases, Ministry of Education, Peking University, Beijing 100191, China
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2
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Lima ACP, Maximiano-Barreto MA, Martins TCR, Luchesi BM. Factors associated with poor health literacy in older adults: A systematic review. Geriatr Nurs 2024; 55:242-254. [PMID: 38070263 DOI: 10.1016/j.gerinurse.2023.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVES To identify factors associated with poor health literacy in older adults. METHODS A systematic literature review was conducted, employing the descriptors "Aged" and "Health Literacy". PROSPERO - CRD 42022350140. RESULTS Out 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). CONCLUSIONS The 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.
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Affiliation(s)
- Ana Caroline Pinto Lima
- Campus de Três Lagoas, Programa de Pós-Graduação em Enfermagem, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil
| | | | - Tatiana Carvalho Reis Martins
- Campus de Três Lagoas, Programa de Pós-Graduação em Enfermagem, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil; Instituto Integrado de Saúde, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Bruna Moretti Luchesi
- Campus de Três Lagoas, Programa de Pós-Graduação em Enfermagem, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil; Research Group on Mental Health, Cognition and Aging, Federal University of São Carlos, São Carlos, SP, Brazil.
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3
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Biasio LR, Zanobini P, Lorini C, Monaci P, Fanfani A, Gallinoro V, Cerini G, Albora G, Del Riccio M, Pecorelli S, Bonaccorsi G. COVID-19 vaccine literacy: A scoping review. Hum Vaccin Immunother 2023; 19:2176083. [PMID: 36794338 PMCID: PMC10026896 DOI: 10.1080/21645515.2023.2176083] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
To address vaccine hesitancy, specific self-rated tools have been developed to assess vaccine literacy (VL) related to COVID-19, including additional variables, such as beliefs, behavior, and willingness to be vaccinated. To explore the recent literature a search was performed selecting articles published between January 2020 and October 2022: 26 papers were identified using these tools in the context of COVID-19. Descriptive analysis showed that the levels of VL observed in the studies were generally in agreement, with functional VL score often lower than the interactive-critical dimension, as if the latter was stimulated by the COVID-19-related infodemic. Factors associated with VL included vaccination status, age, educational level, and, possibly, gender. Effective communication based on VL when promoting vaccination is critical to sustaining immunization against COVID-19 and other communicable diseases. The VL scales developed to date have shown good consistency. However, further research is needed to improve these tools and develop new ones.
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Affiliation(s)
| | - Patrizio Zanobini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Chiara Lorini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Pietro Monaci
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Alice Fanfani
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Veronica Gallinoro
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Gabriele Cerini
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Giuseppe Albora
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Marco Del Riccio
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Sergio Pecorelli
- Scientific Advisory Committee, Giovanni Lorenzini Foundation, Milan, Italy
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Yang Z, Qi Y, Song Q, Zhang Y. Association between exposure to air pollution and memory: the mediating effect of health. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-023-01875-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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Memory performance mediates the relationship between depression and independence in instrumental activities of daily living among community-dwelling older adults: Evidence from the China Family Panel Study. Geriatr Nurs 2023; 50:1-6. [PMID: 36640513 DOI: 10.1016/j.gerinurse.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
Our objective was to examine the link between depression and independence in the instrumental activities of daily living (IADLs) and to explore the mediating role of memory performance through a cross-sectional analysis of a nationally representative sample of community-dwelling older adults in China. In total, 3730 respondents age ≥ 60 (51.7% males) from the 2020 survey of the China Family Panel Study (CFPS) constituted the study sample. Their depressive symptoms, memory performance, and independence in the IADLs were measured. Based on the descriptive statistics, bivariate correlation analysis and bootstrapping mediation analysis were conducted. As hypothesized, independence in the IADLs was negatively related to depression, while it was positively associated with memory performance. Moreover, after controlling for demographic factors, memory performance was demonstrated to be a partial mediator between depression and independence in the IADLs. These findings support the development of clinical interventions which prevent disability or maintain the physical functioning of older adults through alleviating depression and enhancing memory performance.
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Association between WeChat Use and Memory Performance among Older Adults in China: The Mediating Role of Depression. Behav Sci (Basel) 2022; 12:bs12090323. [PMID: 36135127 PMCID: PMC9495430 DOI: 10.3390/bs12090323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022] Open
Abstract
Changes to memory performance in the course of aging may be influenced by behavioral factors. The use of social media among elderly people is increasing, but studying its effect on cognitive functions such as memory remains at an early stage of development. Meanwhile, the linking mechanisms underlying the association between social media use and memory performance, if any exist, have not been revealed. This study attempted to examine the association between the use of WeChat, the most popular social media platform in China, and memory performance among older people, and to test the possible mediating role of depression underlying this association. Data were drawn from the five-wave survey of the China Family Panel Study (CFPS), and 4929 respondents aged 60 or older (mean age = 68.19, SD = 5.84, 48.2% females) were included. Based on the descriptive statistics, the chi-squared test, Student’s t-test, correlation analysis, and mediation analysis were conducted. The results indicated that the usage rate of WeChat among the sample was 20.1%. After controlling for demographic variables, the use of WeChat was related to higher levels of memory performance and lower levels of depression. Moreover, depression partially mediated the relationship between WeChat use and memory performance. To maintain memory performance and promote cognitive health in the course of aging, using social media and alleviating depression merit special attention.
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Chen YM, Chiang TL, Chen DR, Tu YK, Yu HW, Chiu WY. Differing determinants of disability trends among men and women aged 50 years and older. BMC Geriatr 2022; 22:11. [PMID: 34979931 PMCID: PMC8722081 DOI: 10.1186/s12877-021-02574-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 10/22/2021] [Indexed: 11/22/2022] Open
Abstract
Background Researchers have emphasized the importance of examining how different factors affect men’s and women’s functional status over time. To date, the literature is unclear about whether sex affects the rate of change in disability in middle to older age. Researchers have further emphasized the importance of examining how different factors affect men’s and women’s functional status over time. We examined (a) sex differences in disability trends and (b) the determinants of the rate of change in disability for men and women 50 years and older. Methods This study utilized the Taiwan Longitudinal Study on Aging Survey, a nationally representative database (four waves of survey data 1996–2007, N = 3429). We modeled and compared the differences in disability trends and the influences of determinants on trends among men and women using multiple-indicator and multiple-group latent growth curves modeling (LGCM). Equality constraints were imposed on 10 determinants across groups. Results Once disability began, women progressed toward greater disability 18% faster than men. Greater age added about 1.2 times the burden to the rate of change in disability for women than men (p < 0.001). More comorbidities also added significantly more burden to baseline disability and rate of change in disability among women than men (p < 0.001), but women benefited more from higher education levels in lower baseline disability and slower rate of change. Having a better social network was associated with lower baseline disability among women only (p < 0.05). For both men and women, physically active leisure-time activities were beneficial in lower baseline disability (pmen and women < 0.001) and rate of change in disability (pmen < 0.01; pwomen < 0.05), with no significant differences between groups. Conclusions Age may widen the sex gap in the rate of change in disability. However, both sexes benefit from participating in leisure-time activities. Promoting health literacy improves health outcomes and physical function among women. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02574-3.
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Affiliation(s)
- Ya-Mei Chen
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Room 633, No. 17, Xu-Zhou Road, Taipei, 100, Taiwan.
| | - Tung-Liang Chiang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Room 633, No. 17, Xu-Zhou Road, Taipei, 100, Taiwan
| | - Duan-Rung Chen
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Room 636, No. 17, Xu-Zhou Road, Taipei, 100, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 539, No. 17, Xu-Zhou Road, Taipei, 100, Taiwan
| | - Hsiao-Wei Yu
- Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Room 1406, No. 261, Wenhua 1st Rd, Taoyuan, 333, Taiwan
| | - Wan-Yu Chiu
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Room 633, No. 17, Xu-Zhou Road, Taipei, 100, Taiwan
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Wong SS, Lim HM, Chin AJZ, Chang FWS, Yip KC, Teo CH, Abdullah A, Ng CJ. eHealth literacy of patients attending a primary care clinic in Malaysia and its associated factors: A cross-sectional study. Digit Health 2022; 8:20552076221135392. [PMID: 36420318 PMCID: PMC9677303 DOI: 10.1177/20552076221135392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND People are overloaded with online health information (OHI) of variable quality. eHealth literacy is important for people to acquire and appraise reliable information to make health-related decisions. While eHealth literacy is widely studied in developed countries, few studies have been conducted among patients in low- and middle-income countries (LMICs). OBJECTIVE We aimed to determine the level of eHealth literacy in patients attending a primary care clinic in Malaysia and its associated factors. METHODS A cross-sectional study using a self-administered questionnaire was conducted in an urban primary care clinic. We used a systematic random sampling method to select patients aged 18 years and above who attended the clinic. The eHealth literacy scale (eHEALS) was used to measure eHealth literacy. RESULTS A total of 381 participants were included. The mean eHEALS was 24.4 ± 7.6. The eHEALS statements related to skills in appraising OHI were scored lower than statements related to looking for online resources. Higher education level of attending upper secondary school (AOR 2.53, 95% CI 1.05-6.11), tertiary education (AOR 4.05, 95% CI 1.60-10.25), higher monthly household income of >US$470 (AOR 1.95, 95% CI 1.07-3.56), and those who had sought OHI in the past month (AOR 1.95, 95% CI 1.13-3.36) were associated with a higher eHealth literacy level. CONCLUSIONS This study found a low eHealth literacy level among primary care patients in Malaysia. While the patients were confident in searching for OHI, they lacked skills in appraising them. Our findings inform the interventions for improving eHealth literacy in LMICs, especially educating the public about OHI appraisal.
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Affiliation(s)
- Swee Shiuan Wong
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hooi Min Lim
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adrian Jian Zhi Chin
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Felicia Wen Si Chang
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kah Chun Yip
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chin Hai Teo
- University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adina Abdullah
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Research, SingHealth Polyclinics, Singapore
- Duke-NUS Medical School, Singapore
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Yan J, Zheng K, Liu A, Cheng W. The Impact of Cognitive Function on the Effectiveness and Safety of Intensive Blood Pressure Control for Patients With Hypertension: A post-hoc Analysis of SPRINT. Front Cardiovasc Med 2021; 8:777250. [PMID: 34901238 PMCID: PMC8655835 DOI: 10.3389/fcvm.2021.777250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Poor cognitive function can predict poor clinical outcomes. Intensive blood pressure control can reduce the risk of cardiovascular diseases and all-cause mortality. In this study, we assessed whether intensive blood pressure control in older patients can reduce the risk of stroke, composite cardiovascular outcomes and all-cause mortality for participants in the Systolic Blood Pressure Intervention Trial (SPRINT) with lower or higher cognitive function based on the Montreal Cognitive Assessment (MoCA) cut-off scores. Methods: The SPRINT evaluated the impact of intensive blood pressure control (systolic blood pressure <120 mmHg) compared with standard blood pressure control (systolic blood pressure <140 mmHg). We defined MoCA score below education specific 25th percentile as lower cognitive function. And SPRINT participants with a MoCA score below 21 (<12 years of education) or 22 (≥12 years of education) were having lower cognitive function, and all others were having higher cognitive function. The Cox proportional risk regression was used to investigate the association of treatment arms with clinical outcomes and serious adverse effects in different cognitive status. Additional interaction and stratified analyses were performed to evaluate the robustness of the association between treatment arm and stroke in patients with lower cognitive function. Results: Of the participants, 1,873 were having lower cognitive function at baseline. The median follow-up period was 3.26 years. After fully adjusting for age, sex, ethnicity, body mass index, smoking, systolic blood pressure, Framingham 10-year CVD risk score, aspirin use, statin use, previous cardiovascular disease, previous chronic kidney disease and frailty status, intensive blood pressure control increased the risk of stroke [hazard ratio (HR) = 1.93, 95% confidence interval (CI): 1.04–3.60, P = 0.038)] in patients with lower cognitive function. Intensive blood pressure control could not reduce the risk of composite cardiovascular outcomes (HR = 0.81, 95%CI: 0.59–1.12, P = 0.201) and all-cause mortality (HR = 0.93, 95%CI: 0.64–1.35, P = 0.710) in lower cognitive function group. In patients with higher cognitive function, intensive blood pressure control led to significant reduction in the risk of stroke (HR = 0.55, 95%CI: 0.35–0.85, P = 0.008), composite cardiovascular outcomes (HR = 0.68, 95%CI: 0.56–0.83, P < 0.001) and all-cause mortality (HR = 0.62, 95%CI: 0.48–0.80, P < 0.001) in the fully adjusted model. Additionally, after the full adjustment, intensive blood pressure control increased the risk of hypotension and syncope in patients with lower cognitive function. Rates of hypotension, electrolyte abnormality and acute kidney injury were increased in the higher cognitive function patients undergoing intensive blood pressure control. Conclusion: Intensive blood pressure control might not reduce the risk of stroke, composite cardiovascular outcomes and all-cause mortality in patients with lower cognitive function.
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Affiliation(s)
- Jiafu Yan
- Hypertension Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Keyang Zheng
- Hypertension Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Aoya Liu
- Hypertension Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wenli Cheng
- Hypertension Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Psychometric Properties of the Health Literacy Scale Used in the Taiwan Longitudinal Study on Middle-Aged and Older People. Healthcare (Basel) 2021; 9:healthcare9101391. [PMID: 34683071 PMCID: PMC8535643 DOI: 10.3390/healthcare9101391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 11/26/2022] Open
Abstract
Health literacy, an important factor in public and personal health, is regarded as the core of patient-centered care. Older people with high health literacy are more likely to maintain a healthier lifestyle, with good control and management of chronic diseases, than those lacking or with poor health literacy. Purpose: The present study investigated the validity and reliability of the Taiwan Longitudinal Study on Aging (TLSA) Health Literacy Scale. We also evaluated the health literacy of middle-aged and older Taiwanese adults, and its probable association with health outcomes and life satisfaction. Method: We analyzed the internal consistency reliability of the nine items of the 2015 TLSA Health Literacy Scale, and their relationship with the demographic variables. Brody Instrumental Activities of Daily Living (IADL) and the Life Satisfaction Index were used for criterion validity. Moreover, exploratory factor analysis was used to examine the construct validity and to test the known-group validity. Results: The TLSA health literacy scale has good internal consistency reliability. Criterion-related validity was supported by the fact that the health literacy score was significantly correlated with the IADL and Life Satisfaction Index. Factor analysis indicated a three-factor structure. Known-group validity was supported by the results, showing that middle-aged and older people with good self-reported health status had better health literacy. Conclusions: The TLSA health literacy scale is a reliable and valid instrument for measuring health literacy in middle-aged and older people.
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Abd-Rahim SNH, Mohamed-Yassin MS, Abdul-Razak S, Isa MR, Baharudin N. The Prevalence of Limited Health Literacy and Its Associated Factors among Elderly Patients Attending an Urban Academic Primary Care Clinic in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179044. [PMID: 34501632 PMCID: PMC8430857 DOI: 10.3390/ijerph18179044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 12/24/2022]
Abstract
Limited health literacy (HL) is linked to many negative health outcomes, including poor self-management of chronic diseases and medication adherence among patients. There are a lack of data regarding HL in the elderly population in Malaysia. This study aimed to determine the prevalence of limited HL levels and its associated factors among elderly patients in an urban academic primary care clinic in Selangor, Malaysia. A cross-sectional study was conducted among 413 elderly patients (≥60 years old) who attended this academic primary care clinic between January 2020 and January 2021. Sociodemographic data, clinical characteristics, and health literacy scores were collected. Descriptive statistics (median with interquartile ranges (IQR), frequency, and percentages) and multiple logistic regression were utilized. The prevalence of limited HL in our population was 19.1% (95% CI: 15.3, 23). The middle-old (70–79 years) and very-old (≥80 years) age groups were more likely to have limited HL (aOR 4.05; 95% CI: 2.19, 7.52 and aOR 4.36; 95% CI: 1.02, 18.63, respectively). Those with at least secondary school education (aOR 0.06; 95% CI: 0.02, 0.24) and those who found medical information via the internet/television (aOR 0.21; 95% CI: 0.05, 0.93) had lower odds of having limited HL. In conclusion, having limited HL levels was not common among elderly patients in this primary care clinic. Further studies involving rural and larger primary care clinics in Malaysia are required to support these findings.
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Affiliation(s)
- Siti Nur Hidayah Abd-Rahim
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Prima Selayang 7, Batu Caves 68100, Malaysia; (S.N.H.A.-R.); (S.A.-R.); (N.B.)
| | - Mohamed-Syarif Mohamed-Yassin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Prima Selayang 7, Batu Caves 68100, Malaysia; (S.N.H.A.-R.); (S.A.-R.); (N.B.)
- Correspondence: ; Tel.: +60-36-126-4655
| | - Suraya Abdul-Razak
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Prima Selayang 7, Batu Caves 68100, Malaysia; (S.N.H.A.-R.); (S.A.-R.); (N.B.)
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh 47000, Malaysia
- Cardio Vascular and Lungs Research Institute (CaVaLRI), Pusat Perubatan UiTM, Kampus Sungai Buloh, Sungai Buloh 47000, Malaysia
| | - Mohamad Rodi Isa
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh 47000, Malaysia;
| | - Noorhida Baharudin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Prima Selayang 7, Batu Caves 68100, Malaysia; (S.N.H.A.-R.); (S.A.-R.); (N.B.)
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Kosicka B, Deluga A, Bąk J, Chałdaś-Majdańska J, Bieniak M, Machul M, Chrzan-Rodak A, Jurek K, Dobrowolska B. The Level of Health Literacy of Seniors Living in Eastern Region of Poland. Preliminary Study. Healthcare (Basel) 2020; 8:healthcare8030277. [PMID: 32824553 PMCID: PMC7551014 DOI: 10.3390/healthcare8030277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/08/2020] [Accepted: 08/15/2020] [Indexed: 11/16/2022] Open
Abstract
Health literacy (HL) is recognised as an important, modifiable factor in the self-management and health performance of elderly people. The aim of this preliminary study was to identify and analyse the level of health literacy among the elderly living in one of the eastern regions in Poland. The cross-sectional study was conducted among a convenience sample of 200 seniors aged 65+ after cognitive pre-screening with the use of the Montreal Cognitive Assessment (MoCA) scale. To collect data, the Polish version of the HLS-EU-Q47 was used. More than half of the elderly surveyed presented problematic levels of general HL (GEN-HL), and also problematic levels of other dimensions: health care health literacy (HC-HL), disease prevention health literacy (DP-HL), and health promotion health literacy (HP-HL). The level of seniors' HL is dependent on the level of their education, place of living, participation in activities run by Daily Center for the Elderly, and their self-assessment of health condition (p < 0.05). These results imply the important message that there is a need to create initiatives and programs improving health literacy targeted at seniors living in rural areas, those with lower levels of education, and those with poor access to activities organised by institutions supporting seniors.
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Affiliation(s)
- Bogumiła Kosicka
- Department of Management in Nursing, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland;
| | - Alina Deluga
- Department of Family Medicine and Community Nursing, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland; (A.D.); (A.C.-R.)
| | - Jadwiga Bąk
- Department of Paediatric Nursing, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland;
| | - Justyna Chałdaś-Majdańska
- Department of Development in Nursing, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland; (J.C.-M.); (M.B.); (M.M.)
| | - Monika Bieniak
- Department of Development in Nursing, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland; (J.C.-M.); (M.B.); (M.M.)
| | - Michał Machul
- Department of Development in Nursing, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland; (J.C.-M.); (M.B.); (M.M.)
| | - Agnieszka Chrzan-Rodak
- Department of Family Medicine and Community Nursing, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland; (A.D.); (A.C.-R.)
| | - Krzysztof Jurek
- Faculty of Social Sciences, Institute of Sociology, John Paul II Catholic University, 20-950 Lublin, Poland;
| | - Beata Dobrowolska
- Department of Development in Nursing, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland; (J.C.-M.); (M.B.); (M.M.)
- Correspondence:
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McDougall GJ, Han A, Staggs VS, Johnson DK, McDowd JM. Predictors of instrumental activities of daily living in community-dwelling older adults. Arch Psychiatr Nurs 2019; 33:43-50. [PMID: 31711593 PMCID: PMC10613508 DOI: 10.1016/j.apnu.2019.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/22/2019] [Accepted: 08/18/2019] [Indexed: 10/26/2022]
Abstract
Psychiatric mental health clinicians often rely on proxy and self-report evaluations to determine the cognitive function of older adults however, performance measures have greater accuracy and predictive ability for everyday function. This study tested physical and cognitive predictors of functional abilities in fifty-one community residing older adults. We administered a computerized battery of executive function tasks, a performance-based measure of instrumental activities of daily living (IADL), and three physical function measures (grip strength, 30-second Chair Stand Test, and 8-foot Up and Go). Regression models assessed the associations of three components of executive function (updating, shifting, and inhibition) with IADLs and physical functions. Updating was a significant predictor of the Medications and Financial DAFS scores and of grip strength. Shifting also predicted grip strength. In conclusion, different executive functions predict different domains of IADL functioning. Working memory was a robust predictor of IADL functioning in older adults, especially medication management skills.
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Affiliation(s)
- Graham J McDougall
- Florida State University, College of Nursing, Tallahassee, FL 32306-4310, USA.
| | - Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL 35294-1212, USA
| | - Vincent S Staggs
- Health Services & Outcomes Research, Children's Mercy Hospitals and Clinics, and School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - David K Johnson
- Department of Psychology, University of Kansas, Lawrence, KS 66045, USA
| | - Joan M McDowd
- Department of Psychology, University of Missouri - Kansas City, Kansas City, MO 64110, USA
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Geriatric Assessment in Multicultural Immigrant Populations. Geriatrics (Basel) 2019; 4:geriatrics4030040. [PMID: 31247952 PMCID: PMC6787672 DOI: 10.3390/geriatrics4030040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 11/17/2022] Open
Abstract
While the traditional comprehensive geriatric assessment provides valuable information essential to caring for older adults, it often falls short in multicultural immigrant populations. The number of foreign-born older adults is growing, and in some regions of the United States of America (U.S.), they encompass a significant portion of the older adult population. To ensure we are caring for this culturally diverse population adequately, we need to develop a more culturally competent comprehensive geriatric assessment. In this review, we explore ways in which to do this, address areas unique to multicultural immigrant populations, and identify limitations of the current assessment tools when applied to these populations. In order to be more culturally sensitive, we should incorporate the concepts of ethnogeriatrics into a comprehensive geriatric assessment, by addressing topics like healthcare disparities, language barriers, health literacy, acculturation level, and culturally defined beliefs. Additionally, we must be sensitive to the limitations of our current assessment tools and consider how we can expand our assessment toolkit to address these limitations. We discuss the limitations in cognitive screening tests, delirium assessments, functional and mental health assessments, advance care planning, and elder abuse.
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15
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Yu L, Wilson RS, Schneider JA, Bennett DA, Boyle PA. Financial and Health Literacy Predict Incident Alzheimer's Disease Dementia and Pathology. J Alzheimers Dis 2018; 56:1485-1493. [PMID: 28157101 DOI: 10.3233/jad-161132] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Domain specific literacy is a multidimensional construct that requires multiple resources including cognitive and non-cognitive factors. OBJECTIVE We test the hypothesis that domain specific literacy is associated with Alzheimer's disease (AD) dementia and AD pathology after controlling for cognition. METHODS Participants were community-based older persons who completed a baseline literacy assessment, underwent annual clinical evaluations for up to 8 years, and agreed to organ donation after death. Financial and health literacy was measured using 32 questions and cognition was measured using 19 tests. Annual diagnosis of AD dementia followed standard criteria. AD pathology was examined postmortem by quantifying plaques and tangles. Cox models examined the association of literacy with incident AD dementia. Performance of model prediction for incident AD dementia was assessed using indices for integrated discrimination improvement and continuous net reclassification improvement. Linear regression models examined the independent association of literacy with AD pathology in autopsied participants. RESULTS All 805 participants were free of dementia at baseline and 102 (12.7%) developed AD dementia during the follow-up. Lower literacy was associated with higher risk for incident AD dementia (p < 0.001), and the association persisted after controlling for cognition (hazard ratio = 1.50, p = 0.004). The model including the literacy measure had better predictive performance than the one with demographics and cognition only. Lower literacy also was associated with higher burden of AD pathology after controlling for cognition (β= 0.07, p = 0.035). CONCLUSION Literacy predicts incident AD dementia and AD pathology in community-dwelling older persons, and the association is independent of traditional measures of cognition.
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Affiliation(s)
- Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.,Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Patricia A Boyle
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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Nishita Y, Tange C, Tomida M, Otsuka R, Ando F, Shimokata H. Cognitive abilities predict death during the next 15 years in older Japanese adults. Geriatr Gerontol Int 2016; 17:1654-1660. [PMID: 27860108 DOI: 10.1111/ggi.12952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 08/18/2016] [Accepted: 09/20/2016] [Indexed: 11/27/2022]
Abstract
AIM The longitudinal relationship between cognitive abilities and subsequent death was investigated among community-dwelling older Japanese adults. METHODS Participants (n = 1060; age range 60-79 years) comprised the first-wave participants of the National Institute for Longevity Sciences-Longitudinal Study of Aging. Participants' cognitive abilities were measured at baseline using the Japanese Wechsler Adult Intelligence Scale-Revised Short Form, which includes the following tests: Information (general knowledge), Similarities (logical abstract thinking), Picture Completion (visual perception and long-term visual memory) and Digit Symbol (information processing speed). By each cognitive test score, participants were classified into three groups: the high-level group (≥ the mean + 1SD), the low-level group (≤ the mean - 1SD) and the middle-level group. Data on death and moving during the subsequent 15 years were collected and analyzed using the multiple Cox proportional hazard model adjusted for physical and psychosocial covariates. RESULTS During the follow-up period, 308 participants (29.06%) had died and 93 participants (8.77%) had moved. In the Similarities test, adjusted hazard ratios (HR) of the low-level group to the high-level group were significant (HR 1.49, 95% CI 1.02-2.17, P = 0.038). Furthermore, in the Digit symbol test, the adjusted HR of the low-level group to the high-level group was significant (HR 1.62, 95% CI 1.03-2.58, P = 0.038). Significant adjusted HR were not observed for the Information or Picture Completion tests. CONCLUSIONS It is suggested that a lower level of logical abstract thinking and slower information processing speed are associated with shorter survival among older Japanese adults. Geriatr Gerontol Int 2017; 17: 1654-1660.
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Affiliation(s)
- Yukiko Nishita
- Section of National Institute for Longevity Sciences - Longitudinal Study of Aging (NILS-LSA), National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Chikako Tange
- Section of National Institute for Longevity Sciences - Longitudinal Study of Aging (NILS-LSA), National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Makiko Tomida
- Section of National Institute for Longevity Sciences - Longitudinal Study of Aging (NILS-LSA), National Center for Geriatrics and Gerontology, Aichi, Japan.,Research Fellowship of the Japan Society for the Promotion of Science, Tokyo, Japan
| | - Rei Otsuka
- Section of National Institute for Longevity Sciences - Longitudinal Study of Aging (NILS-LSA), National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Fujiko Ando
- Section of National Institute for Longevity Sciences - Longitudinal Study of Aging (NILS-LSA), National Center for Geriatrics and Gerontology, Aichi, Japan.,Faculty of Health and Medical Sciences, Aichi Shukutoku University, Aichi, Japan
| | - Hiroshi Shimokata
- Section of National Institute for Longevity Sciences - Longitudinal Study of Aging (NILS-LSA), National Center for Geriatrics and Gerontology, Aichi, Japan.,Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Aichi, Japan
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17
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Kobayashi LC, Wardle J, Wolf MS, von Wagner C. Aging and Functional Health Literacy: A Systematic Review and Meta-Analysis. J Gerontol B Psychol Sci Soc Sci 2016; 71:445-57. [PMID: 25504637 PMCID: PMC4834761 DOI: 10.1093/geronb/gbu161] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 10/16/2014] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Lindsay C Kobayashi
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, UK.
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, UK
| | - Michael S Wolf
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois. Department of Learning Sciences, School of Education and Social Policy, Northwestern University, Evanston, Illinois
| | - Christian von Wagner
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, UK
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Chesser AK, Keene Woods N, Smothers K, Rogers N. Health Literacy and Older Adults: A Systematic Review. Gerontol Geriatr Med 2016; 2:2333721416630492. [PMID: 28138488 PMCID: PMC5119904 DOI: 10.1177/2333721416630492] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 12/17/2015] [Accepted: 12/30/2015] [Indexed: 11/28/2022] Open
Abstract
Objective: The objective of this review was to assess published literature relating to health literacy and older adults. Method: The current review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses. Results: Eight articles met inclusion criteria. All studies were conducted in urban settings in the United States. Study sample size ranged from 33 to 3,000 participants. Two studies evaluated health-related outcomes and reported significant associations between low health literacy and poorer health outcomes. Two other studies investigated the impact of health literacy on medication management, reporting mixed findings. Discussion: The findings of this review highlight the importance of working to improve health care strategies for older adults with low health literacy and highlight the need for a standardized and validated clinical health literacy screening tool for older adults.
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Batty GD, Deary IJ, Zaninotto P. Association of Cognitive Function With Cause-Specific Mortality in Middle and Older Age: Follow-up of Participants in the English Longitudinal Study of Ageing. Am J Epidemiol 2016; 183:183-90. [PMID: 26803665 DOI: 10.1093/aje/kwv139] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We examined the little-tested associations between general cognitive function in middle and older age and later risk of death from chronic diseases. In the English Longitudinal Study of Ageing (2002-2012), 11,391 study participants who were 50-100 years of age at study induction underwent a battery of cognitive tests and provided a range of collateral data. In an analytical sample of 9,204 people (4,982 women), there were 1,488 deaths during follow-up (mean duration, 9.0 years). When we combined scores from 4 cognition tests that represented 3 acknowledged key domains of cognitive functioning (memory, executive function, and processing speed), cognition was inversely associated with deaths from cancer (per each 1-standard-deviation decrease in general cognitive function score, hazard ratio = 1.21, 95% CI: 1.10, 1.33), cardiovascular disease (hazard ratio = 1.71, 95% CI: 1.55, 1.89), other causes (hazard ratio = 2.07, 95% CI: 1.79, 2.40), and respiratory illness (hazard ratio = 2.48, 95% CI: 2.12, 2.90). Controlling for a range of covariates, such as health behaviors and socioeconomic status, and left-censoring to explore reverse causality had very little impact on the strength of these relationships. These findings indicate that cognitive test scores can provide relatively simple indicators of the risk of death from an array of chronic diseases and that these associations appear to be independent of other commonly assessed risk factors.
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21
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Findley A. Low health literacy and older adults: meanings, problems, and recommendations for social work. SOCIAL WORK IN HEALTH CARE 2015; 54:65-81. [PMID: 25588097 DOI: 10.1080/00981389.2014.966882] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Many older adults struggle to manage their health care problems. Low health literacy exacerbates such struggles and contributes to a variety of adverse health behaviors and outcomes. Addressing how health literacy impinges on the lives of older adults is a neglected area of social work practice and knowledge. This article explores seven areas: defining health literacy, the problem and prevalence of low health literacy among older adults, health inequalities and health literacy, a brief literature review, neglected issues in the literature, suggestions for macro and micro social work interventions to improve health literacy for older adult populations, and conclusion.
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Iwasa H, Kai I, Yoshida Y, Suzuki T, Kim H, Yoshida H. Global cognition and 8-year survival among Japanese community-dwelling older adults. Int J Geriatr Psychiatry 2013; 28:841-9. [PMID: 23008014 DOI: 10.1002/gps.3890] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 09/07/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We sought to examine the longitudinal relationship between cognitive function and all-cause mortality among Japanese community-dwelling older adults, using an 8-year prospective cohort study design with mortality surveillance. METHODS A total of 454 men and 386 women, aged 70 years and older, participated in the study. The Mini Mental State Examination (MMSE) was administered to assess global cognition. The total MMSE score and subscale scores were used as independent variables, and age, gender, education level, chronic disease, sensory deficit, depressive symptoms, and instrumental activities of daily living were used as covariates. RESULTS During the follow-up period, 191 subjects (139 men and 52 women) died, and 64 subjects (31 men and 33 women) moved to a different region of Japan and were lost to follow-up. Use of the multivariate Cox proportional hazards model, adjusted for potential confounders, showed that global cognition was significantly and independently associated with mortality (hazard ratio [HR] = 1.59, 95% confidence interval [CI]: 1.14-2.23 and HR = 2.81, 95% CI: 1.77-4.36 for the middle [24-27 points] and lowest [0-23 points] categories, respectively). Among the MMSE subscales, place orientation (HR = 1.57, 95% CI: 1.09-2.25), calculation (HR = 1.67, 95% CI: 1.18-2.35), and delayed recall (HR = 1.42, 95% CI: 1.03-1.96), were also significantly and independently associated with mortality. CONCLUSIONS Our study suggests that among older individuals, those with lower levels of cognitive function are more likely to have a shorter lifespan compared with those with higher cognitive functioning.
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Affiliation(s)
- Hajime Iwasa
- School of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Sequeira SS, Eggermont LHP, Silliman RA, Bickmore TW, Henault LE, Winter MR, Nelson K, Paasche-Orlow MK. Limited health literacy and decline in executive function in older adults. JOURNAL OF HEALTH COMMUNICATION 2013; 18 Suppl 1:143-157. [PMID: 24093352 PMCID: PMC3807941 DOI: 10.1080/10810730.2013.825673] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Limited health literacy is associated with worse executive function, but the association between limited health literacy and decline in executive function has not been established because of a lack of longitudinal studies. The authors aimed to examine this association by studying a prospective cohort in the setting of a randomized controlled trial to promote walking in older adults. Participants were community-dwelling older adults (65 years of age or older) who scored 2 or more on the Mini-Cog, without depression (score of less than 15 on the 9-item Patient Health Questionnaire), and who completed baseline and 12-month evaluations (n = 226). Health literacy was measured using the Short Test of Functional Health Literacy in Adults. Executive function measured at baseline and 12 months using the Trail Making Test (TMT), Controlled Oral Word Association Test, and Category Fluency. The associations between health literacy and 12-month decline in each test of executive function were modeled using multivariate linear regression. Health literacy was found to be limited in 37% of participants. Limited health literacy was associated with reduced performance on all 3 executive function tests. In fully adjusted models, limited health literacy was associated with greater 12-month decline in performance on the TMT than higher health literacy (p = .01). In conclusion, older adults with limited health literacy are at risk for more rapid decline in scores on the TMT, a measure of executive function.
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Affiliation(s)
| | | | | | | | - Lori E. Henault
- Boston University Medical Center, Boston, Massachusetts, USA
| | | | - Kerrie Nelson
- Boston University Medical Center, Boston, Massachusetts, USA
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