Association between comprehensive health literacy and frailty level in community-dwelling older adults: A cross-sectional study in Japan

The roles of health literacy and social support in the association between smartphone ownership and frailty in older adults: a moderated mediation model

BACKGROUND

Understanding the role of smartphones to promote the health status of older adults is important in the digital society. Little is known about the effects of having smartphones on physical frailty despite its positive effect on the well-being of older adults. This study aimed to explore the association between smartphone ownership and frailty in community-dwelling older adults and its underlying mechanism.

METHODS

We used data from the Korean Frailty and Aging Cohort Study and analyzed 2,469 older adults aged 72-86 years. Frailty, health literacy, and social support were assessed by Fried's frailty phenotype, the Behavioral Risk Factor Surveillance System health literacy module, and the Enhancing Recovery in Coronary Heart Disease (ENRICHD) Social Support Instrument, respectively. The mediation model and moderated mediation model were estimated, where the mediator was health literacy and the moderator was social support, to explore the relationship between smartphone ownership and frailty.

RESULTS

Of our study participants, 58.9% owned smartphones, and 10.9% were classified as frail. Smartphone ownership was negatively associated with frailty (β = -0.623, p < 0.001). Health literacy mediated the relationship between smartphone ownership and frailty (β = -0.154, boot confidence interval [CI] = - 0.222, - 0.096), and social support moderated the mediation effect (β = -0.010, Boot CI = - 0.016, - 0.004).

CONCLUSIONS

Owning smartphones among older adults could reduce the risk of frailty. Promoting health literacy and social support among older adults with smartphones would be effective to prevent frailty.

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

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.

Frailty and medication adherence among older adult patients with hypertension: a moderated mediation model

Objective

Medication adherence has a critical impact on the well-being of older adult patients with hypertension. As such, the current study aimed to investigate the mediating role of health literacy between frailty and medication adherence and the moderating role of educational level.

Methods

This cross-sectional study included patients admitted to the geriatric unit of a hospital. Participants were interviewed using the four-item Morisky Medication Adherence Scale, the Frailty Phenotype Scale, and the Health Literacy Management Scale. Spearman's correlation coefficients were used to assess the association between variables. Mediation and moderated mediation analyses were performed using Process version 4.1 via Model 4 and 14, respectively.

Results

Data from 388 participants were analyzed. The median (IQR [P25-P75]) score for medication adherence was 4.00 (2.00-4.00). Results revealed that after controlling for age, sex, hypertension complication(s) and body mass index, frailty significantly contributed to medication adherence (βtotal -0.236 [95% confidence interval (CI) -0.333 to -0.140]). Medication adherence was influenced by frailty (βdirect -0.192 [95% CI -0.284 to -0.099]) both directly and indirectly through health literacy (βindirect -0.044 [95% CI -0.077 to -0.014]). Educational level moderated the pathway mediated by health literacy; more specifically, the conditional indirect effect between frailty and medication adherence was significant among older adult hypertensive patients with low, intermediate, and high educational levels (effect -0.052 [95% CI -0.092 to -0.106]; effect -0.041 [95% CI -0.071 to -0.012]; effect -0.026 [95% CI -0.051 to -0.006]). The relationship between frailty and medication adherence in older adult patients with hypertension was found to have mediating and moderating effects.

Conclusion

A moderated mediation model was proposed to investigate the effect of frailty on medication adherence. It was effective in strengthening medication adherence by improving health literacy and reducing frailty. More attention needs to be devoted to older adult patients with hypertension and low educational levels.

The Use of Multidimensional Nomial Logistic Model and Structural Equation Model in the Validation of the 14-Item Health-Literacy Scale in Chinese Patients Living with Type 2 Diabetes

Objective

To evaluate the psychometric properties of the 14-item health literacy scale (HL-14) in patients living with type 2 diabetes mellitus (T2DM) in clinical setting.

Methods

Cross-sectional study using item response theory and structural equation modeling (SEM) for testing the item difficulty and three dimensional-HL configurations was adopted in this study. Chinese patients living with T2DM admitted to endocrinology department of Huadong hospital were evaluated by the HL-14 including communication, functional and critical health literacy from August to December 2021.

Results

The multidimensional random coefficients multinomial logistic model indicated the difficulty settings of the scale are appropriate for the study populations, and differential item functioning was not observed for sex in the study. SEM demonstrated that the three-dimensional configuration of the scale is good in the study population (x2/df=2.698, Comparative Fit Index = 0.965, Root Mean Square Error of Approximation = 0.076, standard residual mean root = 0.042).

Conclusion

The HL-14 scale is a reliable and valid measurement, which can perform equitably across sex in evaluating the health literacy in Chinese patients living with T2DM. Moreover, the scale may help fill the gaps of multidimensional health literacy assessment and rapid screening of health literacy ability for clinical practice.

Health Literacy and Exercise to Treat Frailty in Community-Dwelling Older Adults: A National Survey Study

Aging is a major challenge facing modern society and has attracted global attention. Studies have provided some initial evidence that health literacy plays a role in determining frailty; however, most of these studies have used small convenience samples of individuals recruited from geographically limited areas, thus limiting the generalizability of their findings. The present study explored the relationships among health literacy, exercise, and frailty in Taiwanese older adults by using the data of a national population-based survey. We retrieved data from the Taiwan Longitudinal Study on Aging, a population-based survey. We gathered the 2015 data on the age, sex, education level, marital status, exercise habits, and activities of daily living (ADLs) of each eligible respondent. We evaluated the respondents’ health literacy by using a nine-item health literacy scale and categorized their health literacy level as low, medium, or high. Frailty was diagnosed according the Fried criteria. Our final sample consisted of 7702 community-dwelling older adults (3630 men and 4072 adults). Of these, 25.3% had low health literacy. The proportion of respondents who had two or more disabilities in terms of ADLs or instrumental ADLs was higher among the women (36.4% and 12.6%, respectively), and regular exercise was more common among the men (19.6%). Frailty was more prevalent among the women; the prevalence of frailty among the male and female respondents was 4.5% and 8.1%, respectively. High health literacy and regular exercise were protective factors for frailty. According to our results, poor health literacy is a risk factor for prefrailty and frailty, and regular exercise is significantly negatively associated with prefrailty and frailty. Additional studies are necessary to define practical strategies for reducing the risks of disability and death for older adults with low health literacy who do not exercise regularly, thereby improving their quality of life.

Limited health literacy increases the risk of frailty among community-dwelling older adults: Longitudinal findings from the Korean Frailty and Aging Cohort Study

AIM

Despite the growing recognition of the importance of health literacy, there is a lack of knowledge on the longitudinal association between health literacy and frailty. The present study explored whether limited health literacy increases the risk of developing pre-frailty and frailty among older adults.

METHODS

Data were drawn from the Korean Frailty and Aging Cohort Study, a nationwide, population-based prospective cohort study of community-dwelling older Koreans. A baseline sample of 2808 adults aged 70-84 years was analyzed for the cross-sectional models, and 2278 participants in the 2-year follow-up assessment were included for the longitudinal analyses. Multinomial logistic regression models were used to evaluate the relative risk ratios of pre-frailty or frailty, where a robust group served as the reference category.

RESULTS

The findings showed that baseline limited health literacy was associated with an approximately 1.4-fold increased risk of developing pre-frailty after 2 years, even after adjusting for sociodemographic characteristics, health behaviors and health status. However, the longitudinal association between health literacy and frailty was not significant after adjusting for health-related factors.

CONCLUSIONS

Our findings point to the importance of promoting health literacy among older adults, and provide preliminary evidence that can inform the development of tailored public health strategies. Geriatr Gerontol Int 2022; 22: 325-331.

Impact of Health Literacy on the Progression of Frailty after 4 Years among Community-Dwelling Older Adults

Health literacy (HL) promotes healthy lifestyle behaviors among older adults, and its relationship with frailty remains unclear. This study examined whether HL is a predictor of frailty progression among community-dwelling older adults. Data from two surveys conducted in 2012 and 2016 involving older residents (mean age, 71.6 ± 4.6 years) of Kashiwa City, Chiba Prefecture, Japan were used. Only healthy individuals without frailty and cognitive impairments participated in the 2012 assessment, where the Kihon Checklist (KCL), HL, and other variables were assessed. Logistic and multiple logistic analyses were used to assess the effects of HL and other factors on frailty between the 'high HL' vs. 'low HL' groups in 2012 and between the 'robust' vs. 'frailty-progressing' groups in 2016. Of the 621 robust participants, 154 (25.4%) had progression of frailty in 2016, which was significantly associated with advanced age, higher KCL score, lower HL, poor mental health, and lack of social support. Furthermore, low HL was a predictor of frailty progression. Low HL may be associated with frailty progression. The obtained results suggest that increased health literacy should be effective in preventing frailty for community-dwelling older residents.

Associated Factors and Health Outcomes of Health Literacy and Physical Frailty Among Older Adults: A Systematic Review

The current review aimed to systematically describe and synthesize health outcomes and factors associated with health literacy and physical frailty among older adults. Seven electronic databases were searched for observational studies published in English, from database inception to March 31, 2021. The study protocol was registered with PROSPERO. Two reviewers independently performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale. Among the 479 studies identified, nine (6,337 participants) met eligibility criteria. Common factors associated with health literacy and physical frailty were lower educational level, multiple comorbidities, and cognitive dysfunction. Health literacy was mainly associated with self-reported outcomes, whereas physical frailty was related to clinical outcomes. Prospective studies are required to identify the impact of limited health literacy, combined with frailty, on long-term health outcomes in older adults. Health literacy interventions should consider the older adult population with multiple comorbidities. [Research in Gerontological Nursing, xx(x), xx-xx.].

Cognitive Frailty in Thai Community-Dwelling Elderly: Prevalence and Its Association with Malnutrition

Cognitive frailty (CF) is defined by the coexistence of physical frailty and mild cognitive impairment. Malnutrition is an underlying factor of age-related conditions including physical frailty. However, the evidence associating malnutrition and cognitive frailty is limited. This cross-sectional study aimed to determine the association between malnutrition and CF in the elderly. A total of 373 participants aged 65-84 years were enrolled after excluding those who were suspected to have dementia and depression. Then, 61 CF and 45 normal participants were randomly selected to measure serum prealbumin level. Cognitive function was assessed using the Montreal Cognitive Assessment-Basic (MoCA-B). Modified Fried's criteria were used to define physical frailty. Nutritional status was evaluated by the Mini Nutritional Assessment-short form (MNA-SF), serum prealbumin, and anthropometric measurements. The prevalence of CF was 28.72%. Malnourished status by MNA-SF category (aOR = 2.81, 95%CI: 1.18-6.67) and MNA-SF score (aOR = 0.84, 95%CI = 0.74-0.94) were independently associated with CF. However, there was no correlation between CF and malnutrition assessed by serum prealbumin level and anthropometric measurements. Other independent risk factors of CF were advanced age (aOR = 1.06, 95%CI: 1.02-1.11) and educational level below high school (aOR = 6.77, 95%CI: 1.99-23.01). Malnutrition was associated with CF among Thai elderly. High-risk groups who are old and poorly educated should receive early screening and nutritional interventions.

Research on Influencing Factors and Dimensions of Health Literacy in Different Age Groups: Before and After the COVID-19 Era in Chongqing, China

Background: Understanding the levels of health literacy among different groups is essential for better public health interventions targeting specific subgroups of the population. Additionally, this article explores the prevalence and influencing factors of the health literacy levels of different age groups during the COVID-19 epidemic. Methods: Multistage stratified cluster random sampling and the Probability Proportion to Size (PPS) method were used to select permanent residents aged 15-69 in Chongqing (54,706) for the questionnaire survey. The survey period is from July 2019 and July 2020. Single-factor analysis and logistic regression models were used to study the relationship between demographics, socioeconomic factors, other independent covariates, and health literacy. Results: The health literacy levels of residents declined with age, and there were significant differences in health literacy levels between age groups (χ² = 3332.884, P < 0.05). As far as the factors affecting health literacy level are concerned, high education and high income are the protective factors for health literacy level for residents of all ages. For adolescents (OR = 1.383, 95% CI: 1.217-1.571), young adults (OR = 1.232, 95% CI = 1.117-1.358), and middle-aged people (OR = 1.096, 95% CI = 1.017-1.182), residence in rural areas was a protective factor. In terms of the dimensions of health literacy, in particular, elderly health literacy in 2020 in Scientific Health Concepts, Safety and First Aid, Basic Medical Care decreased significantly compared with 2019. Conclusions: For adolescents, young adults, middle-aged people, to solve the problem of urban and rural health quality gap, we should not only use the geographical division, but also consider the social population and socio-economic differences. For the elderly, the following four dimensions of health literacy need to be paid more attention than those of other age: Basic Knowledge and Concepts, Scientific Health Concepts, Safety and First Aid, and Basic Medical Care. A lack of knowledge on the prevention and treatment of chronic diseases is the main reason for the recent decline in health literacy. And the health literacy among residents in major public health emergencies is needed.

Health Literacy and Frailty in Community-Dwelling Older Adults: Evidence from a Nationwide Cohort Study in South Korea

Health literacy is closely associated with poor health outcomes and mortality. However, only a handful of studies have examined the association between health literacy and frailty status. The current study used data from a nationwide sample of Korean adults aged 70-84 collected from 10 cities, each of which represents a different region of South Korea (n = 1521). We used the propensity score matching (PSM) method to minimize the potential selection bias and confounding factors that are present in observational studies. After PSM, demographic and health-related characteristics between the limited health literacy (n = 486) and the nonlimited health literacy (n = 486) groups were not significantly different. Multinomial logistic regression analyses were conducted for the PSM-matched sample to examine the association between health literacy and frailty outcomes, where the robust group was set as a reference. Limited health literacy significantly increased the risk of pre-frailty (RRR = 1.45, p = 0.02) and frailty (RRR = 2.03, p = 0.01) after adjusting for demographic and health-related factors. Our findings underscore the need to foster health literacy programs and provide preliminary evidence to inform tailored intervention programs so that we might attenuate the risk of frailty in the older population.

Moderating effect of age on the relationships between pre-frailty and body measures

This study aims to investigate the relationship between body measures and the presence of two frailty-related phenotypes, and the moderating effect of age on this relationship. This is a secondary data analysis of the baseline data of an interventional study. The participants were residents of seven districts in Hong Kong, aged 55 or older, able to ambulate independently and to function well cognitively. Pre-frailty refers to the presence of two frailty-related phenotypes: low physical activity or poor handgrip strength or both. Included in the study were 199 individuals with a mean age of 73.43 (SD 7.54). Regression models showed that body weight (OR = 0.95, 95% CI 0.92-0.99, p < .05) was significantly associated with pre-frailty, as was body height (OR = 0.88, 95% CI 0.83-0.94, p < .001). Age is a significant moderator of the relationship between pre-frailty and body weight and body height. The effect of body weight (beta = -0.044, p < .05) and height (beta = -0.16, p < .001) on pre-frailty was significant and negative in the younger age groups. The findings indicate that raw body measures (i.e. body weight, body height) are more predictive of pre-frailty than BMI in older Chinese people. However, in the old-old group, these measures are not significant predictors of pre-frailty in Chinese community-dwelling adults. Practitioners should consider adopting body measures as predictors of pre-frailty in the younger-old population.

[Effects of health literacy on frailty status at two-year follow-up in older adults: A prospective cohort study]

AIM

To investigate the longitudinal association between health literacy and frailty status at two-year follow-up in community-dwelling older adults.

METHODS

A total of 218 older adults (mean age, 72.5±4.9 [range 65-86] years old; men, n=81) without frailty at baseline participated in this study. Functional health literacy was assessed using the Newest Vital Sign (NVS). Comprehensive health literacy was assessed using the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47). Comprehensive health literacy indices are constructed as a general health literacy index comprising all items along with the three sub-indices of health care, disease prevention, and health promotion domains. Demographic data and other potential confounding factors were also assessed. The total Kihon checklist score was used to monitor the presence of frailty based on a score of ≥8 at the 2-year follow-up (postal survey).

RESULTS

Of the 253 participants in the follow-up survey, 226 responded (response rate: 89.3%). Excluding the 8 participants with missing values, 25 (11.5%) of the 218 were reported to be frail. A multiple logistic regression analysis indicated that comprehensive health literacy (total score of HLS-EU-Q47) was independently associated with a lower risk of frailty (odds ratio per standard deviation = 0.54, 95% confidence interval = 0.33-0.87) after adjusting for the covariates (age, gender, education, body mass index, gait speed, cognitive function, and comorbidities). The health care and disease prevention domain scores of the HLS-EU-Q47 were also independently associated with a lower risk of frailty. Functional health literacy (NVS score) was not associated with frailty.

CONCLUSIONS

Older adults with higher comprehensive health literacy are less likely to be frail at two-year follow-up than those with a lower literacy.

Association of Health Literacy with the Implementation of Exercise during the Declaration of COVID-19 State of Emergency among Japanese Community-Dwelling Old-Old Adults

Health literacy is important for promoting and maintaining good health in old-old adults. It may influence the implementation of exercise in the coronavirus disease epidemic. The present cross-sectional study investigated the association of each dimension of health literacy with the implementation of exercise during the declaration of a state of emergency due to coronavirus disease in community-dwelling old-old adults. We collected data from 483 community-dwelling old-old adults (52.8% women) aged between 77 and 99 years who participated in a mail survey. Participants were divided into exercise or nonexercise groups based on the implementation of exercise during the declaration of a state of emergency. Health literacy was assessed using a 14-item health literacy scale. There were 327 (67.7%) participants in the exercise group and 156 (32.3%) in the nonexercise group. A significantly higher score of health literacy was observed in the exercise group than in the nonexercise group (communicative health literacy score = 14.0 ± 3.6 vs. 12.7 ± 3.8, p = 0.001). In a multivariate logistic regression model adjusted for potential confounders, high communicative health literacy scores were significantly associated with the implementation of exercise during the declaration of a state of emergency (odds ratio = 1.88, 95% confidence interval = 1.20–2.93). Approximately two-thirds of community-dwelling old-old adults implement exercise during the declaration of a state of emergency. High communicative health literacy was associated with the implementation of exercise during this period.

Pathways among Frailty, Health Literacy, Acculturation, and Social Support of Middle-Aged and Older Korean Immigrants in the USA

Culturally and linguistically different immigrants in the U.S. are considered populations with low health literacy in general, thereby having a high risk of negative health outcomes such as frailty. The purpose of this study is to identify the effects of social support and acculturation on the relationship between health literacy and frailty of Korean immigrants in existing models of health literacy. A total of 244 Korean immigrants aged 50 years and older residing in Southern United States (Alabama and Georgia) were recruited. Path analysis was used to examine the pathways among variables, and the indirect effects of health literacy were analyzed. The results revealed that health literacy and social support directly influenced frailty; social support and acculturation were identified to influence health literacy. Health literacy had a partial mediating effect in the relationship between social support and frailty and a complete mediating effect in the relationship between acculturation and frailty. Therefore, to prevent frailty, it is necessary to consider enhancing immigrants' health literacy by elevating acculturation and social supports.

Promoting Problem Solving About Health Management: A Mixed-Methods Pilot Evaluation of a Digital Health Intervention for Older Adults With Pre-Frailty and Frailty

Background: There is a need for interventions to promote health management of older adults with pre-frailty and frailty. Technology poses promising solutions, but questions exist about effective delivery. Objectives: We present the results of a mixed-methods pilot evaluation of Virtual Online Communities for Older Adults (VOCALE), an 8-week intervention conducted in the northwestern United States, in which participants shared health-related experiences and applied problem solving skills in a Facebook group. Methods: We performed a mixed-methods process evaluation, integrating quantitative and qualitative data, to characterize the intervention and its effects. We focus on four areas: health-related measures (health literacy and self-efficacy), participation, problem solving skills enacted, and subjective feedback. Results: Eight older adults with pre-frailty and frailty (age = 82.7 ± 6.6 years) completed the study. There was an upward trend in health literacy and health self-efficacy post-intervention. Participants posted at least two times per week. Content analysis of 210 posts showed participants were able to apply the problem solving skills taught, and exit interviews showed participants' increased awareness of the need to manage health, and enjoyment in learning about others. Conclusion: This mixed-methods evaluation provides insight into feasibility and design considerations for online interventions to promote health management among vulnerable older adults.

"Context, content, and system" supporting digital health hub (DHH)-enabled models of care (MoCs) for fragility hip fractures: perspectives of diverse multidisciplinary stakeholders in South Australia from qualitative in-depth interviews

Combining thematic analysis and a human-computer persuasive systems framework suggests that hip fracture recovery among older people can be enhanced through person-centered digital health hub models of care focused on behavior change education and integrated care. The findings intend to guide settings involving comorbid conditions and low- and middle-income countries in developing innovative digital health solutions.

PURPOSE

The purpose of this study was to understand stakeholders' perspectives on the development of a digital health-enabled model of care for fragility hip fractures and to map out factors that could influence the design and implementation of such a model.

METHODS

Qualitative in-depth interviews were conducted with stakeholders from various clinical disciplines, allied health, and computer science. A hybrid process involving thematic analysis of the raw data using inductive coding was the first step. In the second step, the tenets of a theoretical framework (health behavior change supporting systems) were deductively applied to the thematic constructs generated as part of the first step of the analysis.

RESULTS

In total, 24 in-depth interviews were conducted with stakeholders. We identified 18 thematic constructs presented under the categories of context, content, and system. Context covered patient characteristics such as frailty, digital literacy, and patient or carer participation, whereas healthcare delivery aspects included the structure and culture of existing practice and the need for innovative holistic models of care. Content outlines the active ingredients and approach in developing a digital health hub, and it highlights the importance of targeted education and behavior change. The system is a complicated matrix crossing different aspects of healthcare and offering a value proposition design through personalization across modes of content delivery. This must foster trust, ensure adequate financing, and support ownership and privacy by establishing appropriate mechanisms for embedding change.

CONCLUSION

The findings from this study provide insights around potential factors related to patients, community support, and healthcare delivery influencing the design and next-stage implementation of a digital health hub model of care for fragility hip fractures.

Cluster of factors associated with physical frailty in community-dwelling elderly people

Abstract Frailty is characterized as a set of factors related to the body structure that lead the subject to a process of physical vulnerability, increasing their dependence. The study aims to investigate the aggregation of factors related to physical frailty (PF) in elderly residents of a city with a low Human Development Index (HDI). This is a cross-sectional study carried out in the city of Ibicuí, state of Bahia, Brazil, and including a random 270 elderly people aged ≥ 60 years. The physical frailty condition was identified according to the criteria proposed by Fried and collaborators. In the data analysis, descriptive statistics, cluster analysis, and multinominal logistic regression procedures were used. The highest prevalence of aggregation was identified when the four risk factors were combined: weight loss, strength, walking speed and physical activity levels (O/E = 4.36; CI = 4.04 - 4.68). It was identified that older people (80 years old or more) with a lower level of education (unlettered) were more likely to have three or more risk factors for physical frailty (p <0.05). As for sociodemographic variables, those who were older and had lower levels of education were more likely to have three or more risk factors. The development of actions that encourage a healthier lifestyle to favor the prevention and treatment of physical frailty, as well as to increase health literacy and knowledge, may reduce the problems related to this condition in older adults, mainly thinking about the next generations.

Low Health Literacy Is Associated With Frailty and Reduced Likelihood of Liver Transplant Listing: A Prospective Cohort Study

The effect of low health literacy (HL) on outcomes in end-stage liver disease (ESLD) is largely unknown. The association of low HL on clinical outcomes was investigated in a prospective cohort of outpatients with ESLD undergoing liver transplantation (LT) evaluation. From 2014 to 2017, 276 patients underwent LT evaluation with assessments of liver disease severity, medical and psychosocial comorbidities, physical frailty, and malnutrition. Literacy was measured with the Newest Vital Sign, a brief validated assessment. Multivariate models assessed relationships between HL and clinical outcomes adjusting for clinical and psychosocial variables. The median Model for End-Stage Liver Disease-sodium score of the study sample was 15 (interquartile range, 11-19), 71 (25.7%) of candidates were frail, 117 (42.4%) had malnutrition, 151 (54.7%) had hepatic encephalopathy, 104 (37.7%) had low HL, and 85 (39.2%) had marginal or poor social support. Adjusting for education level, socioeconomic factors, and severity of illness, low HL was independently associated with physical frailty (adjusted odds ratio [aOR], 3.59; 95% confidence interval [CI], 1.50-8.59; P = 0.004) and not being wait-listed (aOR 1.96; 95% CI, 1.03-3.75; P = 0.04). Strong social support attenuated the relationship between low HL and not being wait-listed (aOR, 1.58; 95% CI, 0.74-3.36; P = 0.24). Low HL is common and a largely unrecognized risk factor for poor health outcomes among patients with ESLD. Patient-oriented infrastructure and support are needed at the health system level to ensure all patients can successfully navigate the complex process of LT evaluation and wait-listing.

The Association between Health Literacy and Gait Speed in Community-Dwelling Older Adults

The association between gait speed, a vital health outcome in older adults, and health literacy, an important health promotion aspect, is unclear. This study examined the relationship of gait speed with health literacy, physical function, and cognitive function in community-dwelling older adults. The subjects were 240 older adults (52 men, mean age 73.8 ± 6.0 years). Gender, age, and education were self-reported, while height and weight were measured directly. Health literacy was evaluated using Communicative and Critical Health Literacy (CCHL). Grip strength, knee extension strength, toe-grip strength, sit-up test, sit-and-reach test, one-leg stance test time, 30-s chair-stand test (CS-30), and normal gait speed were measured. Subjects were divided into two groups based on normal gait speed—fast (speed ≥ 1.3 m/s) and slow (<1.3 m/s). In the logistic regression analysis, the dependent variable was normal gait speed (fast/slow). Four logistic regression models were utilized to determine whether health literacy affects gait speed. Height and CCHL were found to independently affect gait speed. That health literacy influences gait speed is a new discovery.

Cocreation of a digital patient health hub to enhance education and person-centred integrated care post hip fracture: a mixed-methods study protocol

INTRODUCTION

Older people with hip fractures often require long-term care and a crucial aspect is the provision of quality health information to patients and their carers to support continuity of care. If patients are well informed about their health condition and caring needs, particularly posthospital discharge into the community setting, this may support recovery and improve quality of life. As internet and mobile access reach every household, it is possible to deliver a new model of service using a digital education platform as a personal health hub where both patients and their providers of care can establish a more efficient information integration and exchange process. This protocol details proposed research, which aims to develop a 'model of care' by using a digital health solution that will allow delivery of high quality and patient-centred information, integrated into the existing process delivered within the community setting.

METHODS AND ANALYSIS

This phase of the study uses a pragmatic mixed-methods design and a participatory approach through engagement of patients, their carers and healthcare providers from multiple disciplines to inform the development of a digital health platform. Quantitative methods will explore health literacy and e-health literacy among older people with hip fractures admitted to the two public tertiary care hospitals in Adelaide, South Australia. Qualitative methods will provide an understanding of aspects of content and context required for the digital health platform to be developed in order to deliver quality health information. The study will use appropriate theoretical frameworks and constructs to guide the design, analysis and overall conduct of the research study. The scope of the study intends to ultimately empower patients and their carers to improve self-management and to better use coordinated services at the community level. This could prevent further falls including associated injuries or new fractures; reduce new hospital admissions and improve confidence and engagement by limiting the psychologically restrictive 'fear of falls'.

ETHICS AND DISSEMINATION

The study has been approved by the Human Research Ethics Committee of the Central Adelaide Local Health Network, South Australia (SA) Health, Government of South Australia and the University of Adelaide Human Research Ethics Committee. Findings from the study will be published in suitable peer-reviewed journals and disseminated through workshops or conferences.

The association of health literacy, numeracy and graph literacy with frailty

BACKGROUND

Frailty is a state of vulnerability to stressors which may result in high mortality, morbidity, and health-care utilization in older adults. Whether health literacy, graph literacy and numeracy are associated with frailty is unknown.

AIM

To assess the association of health literacy, numeracy and graph literacy with frailty in male veterans.

METHODS

This is a retrospective study of 470 cognitively intact, non-depressed veterans who completed evaluations of health literacy, numeracy and graph literacy at Miami VA facility in 2012. A 43-item frailty index was created as a proportion of all potential variables (demographics, comorbidities, number of medications, laboratory tests, and activities of daily life). Odds ratios and 95% confidence intervals were calculated by multinomial logistic regression models with frailty status (robust, prefrail and frail) as the outcome variable, and with health literacy, numeracy, and graph literacy scores as independent variables. Age, race, ethnicity, education, socio-economic status, and comorbidities were considered as covariates.

RESULTS

Patients were 100% male, 40% White, 82% non-Hispanic, mean age was 56.8 years. The proportion of robust, pre-frail and frail was 10.0%, 61.3% and 28.7%, respectively. Neither health literacy nor objective nor subjective numeracy was associated with frailty after adjustment for covariates. In contrast, higher graph literacy scores were associated with a lower risk for frailty (p = .015) even after adjusting known risk factors for frailty.

DISCUSSION AND CONCLUSION

Neither health literacy nor numeracy is associated with frailty. Higher graph literacy score is associated with a lower risk for frailty even after adjusting for known risk factors for frailty.

Health-promoting lifestyles of Japanese expatriates residing in the Philippines and Thailand

Background:

The number of Japanese expatriates has increased, many of whom undertake lifestyle changes to improve their health.

Purpose:

We aim to clarify the health-promoting lifestyles of middle and older age Japanese expatriates.

Methods:

This is a cross-sectional study. Participants comprised 95 long-term Japanese expatriates residing in popular destinations: the Philippines and Thailand. Health behavior was evaluated using a Japanese version of Health-Promoting Lifestyle Profile II and participants were compared with a group living in Japan. Multiple linear regression analyses were used to examine the factors that correlate with the score of physical activity, a Health-Promoting Lifestyle Profile II subscale.

Results:

The expatriates had significantly higher scores of physical activity and nutrition than the group living in Japan. Factors positively related to physical activity were communicative literacy, information on health management before leaving Japan, no history of hypertension, and sufficient English proficiency.

Conclusion:

The Japanese expatriates we studied were physically active and were careful about nutrition. To further increase their physical activity, better access to health information and enhancement of communicative literacy and of English proficiency are desired.

Limited formal education is strongly associated with lower cognitive status, functional disability and frailty status in older adults

Limited formal education is still common in ageing populations. Although limited formal education seems to be independently and negatively associated with cognition, functional abilities and frailty in ageing, no studies have examined whether the gradient of limited formal education has an impact on health in later life.

Frailty syndrome among elderly and associated factors: comparison of two cities

OBJECTIVE

to compare the frailty syndrome among elderly people living at home in two Brazilian cities and to identify factors related to sociodemographic and health-related variables.

METHOD

population-based cross-sectional study with 480 elderly individuals from the cities of Ribeirão Preto/SP and João Pessoa/PB, with application of the Mini Mental State Examination instruments and the Edmonton Frailty, Geriatric Depression and Lawton and Brody scales. Descriptive analysis, Chi-square test, Fisher's test, Student's t-test, Spermann's correlation and Logistic regression were used. In all analyzes, the level of significance was set at p≤0.05.

RESULTS

in relation to frailty, it was verified that living in Ribeirão Preto, presenting advanced age, low schooling, multiple chronic diseases, reduced cognitive status and functional capacity, besides depressive symptoms, are factors associated with the frailty syndrome, in both cities.

CONCLUSION

we identified that the frailty syndrome in the elderly of both cities has a relation with the place where the elderly person lives, age, schooling, number of diseases, reduction of cognitive status, functional capacity and presence of symptoms depressive.

Impact of Health Literacy on Frailty among Community-Dwelling Seniors

Health literacy has been reported to have effects on health behavior change and health-related outcomes, but few studies have explored the association between health literacy and frailty. The aim of our study is to investigate the relationships between health literacy and frailty among community-dwelling seniors. This cross-sectional study enrolled 603 community-dwelling older adults (307 women) in residential areas, with a mean age of 70.9 ± 5.82 years. Health literacy was assessed using the Mandarin version of the European Health Literacy Survey Questionnaire. Physical frailty was defined by Fried frailty phenotype. Logistic regression was carried out to determine potential risk factors of frailty. In the multivariate logistic regression model, physical activity (Odds Ratio [OR] 1.47, 95% Confidence Interval [CI] 1.06–2.03) and health literacy (sufficient vs. excellent: OR 2.51, 95% CI 1.32–4.77) were associated with prefrailty and frailty. In subgroup analysis, pre-frailty and frailty were also negatively associated with health literacy in individuals with ‘insufficiently active’ (inadequate vs. excellent: OR 5.44, 95% CI 1.6–18.45) and ‘sufficiently/highly active’ physical activity levels (sufficient vs. excellent: OR 2.41, 95% CI 1.07–5.42). Therefore, in these community-dwelling elderly adults, health literacy was associated with pre-frailty and frailty regardless of age, gender, socio-economic status, and education level.