1
|
Modiano YA, Woods SP. Health literacy is associated with cognition and everyday functioning in a consecutive clinical series of people with epilepsy in a surgical setting. Epilepsy Behav 2024; 159:110013. [PMID: 39182261 DOI: 10.1016/j.yebeh.2024.110013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 08/13/2024] [Accepted: 08/21/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVE Low health literacy is common among people with epilepsy (PWE) and may play an important role in disease management and outcomes. The current study evaluated whether health literacy is related to cognition, health, and everyday functioning in PWE. METHODS This cross-sectional, correlational study included 25 demographically comparable healthy adults retrospectively matched to a consecutive series of 89 PWE presenting for neuropsychological evaluation in a surgical setting and who completed the Newest Vital Sign and Brief Health Literacy Screener. The PWE also completed a comprehensive neuropsychological battery and measures of quality of life and everyday functioning. RESULTS PWE had significantly lower health literacy as compared to healthy adults (ps < 0.05) at a medium-to-large effect size. In analyses covarying for education and oral word reading literacy in the PWE sample, lower health literacy was independently associated with bilateral seizure onsets, greater antiseizure medication burden, poorer performance on measures of memory and information processing speed, and difficulties with self-care (ps < 0.05). SIGNIFICANCE Findings suggest that PWE are at risk for low health literacy, which may be partly attributable to disrupted brain-behavior relationships and contribute to poorer everyday functioning. Future studies are needed to identify effective methods to support and improve health literacy in PWE.
Collapse
Affiliation(s)
- Yosefa A Modiano
- Vivian L. Smith Department of Neurosurgery and Texas Institute for Restorative Neurotechnologies, UTHealth Houston, Houston, TX, USA.
| | | |
Collapse
|
2
|
Chow BC, Jiao J, Duong TV, Hassel H, Kwok TCY, Nguyen MH, Liu H. Health literacy mediates the relationships of cognitive and physical functions with health-related quality of life in older adults. Front Public Health 2024; 12:1355392. [PMID: 38550320 PMCID: PMC10976439 DOI: 10.3389/fpubh.2024.1355392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/16/2024] [Indexed: 04/02/2024] Open
Abstract
Background Declining cognitive function (CF) and physical function (PF) relate to poorer health-related quality of life (HRQoL) in older adults. As health literacy (HL) facilitates health information utilization, it may mediate links between functionality and HRQoL appraisals. This study examined HL as an intermediary between joint CF and PF contributions and HRQoL in Hong Kong older adults. Methods 490 older adults aged 50-80 years completed assessments from March to July 2021. Health Literacy Survey Questionnaire Short Form 12 questions (HLS-SF12), Montreal Cognitive Assessment (MoCA), Senior Fitness Test (SFT) and 12-Item Short-Form Health Survey version 2 (SF-12v2) were used to assess HL, CF, PF and HRQoL, respectively. Path analysis tested a model with HL mediating CF/PF predictors and HRQoL outcome. Results Results for direct effects indicated that CF significantly associated with PF (β = 0.115, SE = 0.012, p < 0.001), PF significantly connected to HL (β = 0.101, SE = 0.022, p < 0.001), and HL significantly related to HRQoL (β = 0.457, SE = 0.049, p < 0.001). Meanwhile, PF significantly linked to HRQoL directly (β = 0.156, SE = 0.025, p < 0.001) as well as indirectly (β = 0.046, 95% CI [0.028, 0.067]). Significant mediating effect of HL was found on the relationship of PF and HRQoL. Conclusion Findings confirm CF and PF joint impacts on HL and HRQoL in older adults, elucidating HL's mediating role in translating functionality levels into HRQoL. Fostering enduring health knowledge access may thus buffer effects of age-related declines on well-being. Results can inform interventions leveraging this pathway to promote resilient trajectories.
Collapse
Affiliation(s)
- Bik C. Chow
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
- Dr. Stephen Hui Research Centre for Physical Recreation and Wellness, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
| | - Jiao Jiao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
- Dr. Stephen Hui Research Centre for Physical Recreation and Wellness, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
| | - Tuyen V. Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
- International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Holger Hassel
- Institute for Applied Health Sciences, Coburg University of Applied Sciences and Arts, Coburg, Germany
- Berlin Institute for Health and Social Affairs, Berlin, Germany
| | - Timothy C. Y. Kwok
- Department of Medicine & Therapeutic and School of Public Health, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Minh H. Nguyen
- International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Huaxuan Liu
- School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, Fujian, China
| |
Collapse
|
3
|
Siconolfi D, Thomas EG, Chen EK, Haberlen SA, Friedman MR, Ware D, Meanley S, Brennan-Ing M, Brown AL, Egan JE, Bolan R, Stosor V, Plankey M. Advance Care Planning Among Sexual Minority Men: Sociodemographic, Health Care, and Health Status Predictors. J Aging Health 2024; 36:147-160. [PMID: 37249419 PMCID: PMC10687306 DOI: 10.1177/08982643231177725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Objectives: Advance care planning (ACP) specifies decision-making surrogates and preferences for serious illness or end-of-life medical care. ACP research has largely neglected sexual minority men (SMM), a population that experiences disparities in health care and health status. Methods: We examined formal and informal ACP among SMM ages 40+ in the Multicenter AIDS Cohort Study (N = 1,071). Results: For informal ACP (50%), younger SMM and men with past cardiovascular events had greater odds of planning; single men had lower odds of planning. For formal ACP (39%), SMM with greater socioeconomic status had greater odds of planning; SMM who were younger, of racial/ethnic minority identities, who were single or in a relationship without legal protections, and who lacked a primary care home had lower odds of planning. Discussion: Findings warrant further exploration of both informal and formal planning. More equitable, culturally-humble engagement of SMM may facilitate access, uptake, and person-centered planning.
Collapse
Affiliation(s)
| | | | | | | | - M Reuel Friedman
- Rutgers School of Public Health, Rutgers University, Newark, NJ, USA
| | - Deanna Ware
- Georgetown University Medical Center, Washington, DC, USA
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, New York, NY, USA
| | - Andre L Brown
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | | | - Valentina Stosor
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | |
Collapse
|
4
|
Mavedatnia D, Wang L, Kiss A, Monteiro E, Lin V. Health literacy of patients eligible for cochlear implants. Cochlear Implants Int 2024; 25:122-130. [PMID: 38810103 DOI: 10.1080/14670100.2024.2341208] [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] [Indexed: 05/31/2024]
Abstract
BACKGROUND Hearing loss is known to be an independent risk factor for inadequate health literacy. The objective of this study was to assess the level of health literacy among patients undergoing cochlear implantation to determine areas for improvement in delivery of patient information. METHODS A cross-sectional survey was conducted at the otology-neurotology clinic at Sunnybrook Health Sciences Centre. Patients eligible for cochlear implantation completed two health literacy screening tools: The Short Test of Functional Health Literacy in Adults (S-TOFHLA) and Brief Health Literacy Screen (BHLS). RESULTS Thirty seven patients were included (41% female, 59% male, mean age: 55 years). Most patients had adequate health literacy through BHLS (76%) and S-TOFHLA (98%) scoring. Over 80% of patients were not able to correctly recount all the operative risks associated with cochlear implant surgery and one third of patients did not correctly recount any risks associated with a cochlear implant surgery. Female sex was associated with higher scores (p=0.03) and low income (<$35,000) was associated with lower scores (p=0.05). CONCLUSION Patients eligible for cochlear implants have adequate health literacy, but most are not able to recount operative risks. Educational tools are required to improve patient retention, understand, and perioperative health information delivery.
Collapse
Affiliation(s)
- Dorsa Mavedatnia
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Lily Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alex Kiss
- Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Lin
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Agner J, Bau KE, Bruland D. An Introduction to Health Literacy and Social Contexts with Recommendations for Health Professionals and Researchers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:240. [PMID: 38397728 PMCID: PMC10888032 DOI: 10.3390/ijerph21020240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/19/2024] [Indexed: 02/25/2024]
Abstract
Rarely do individuals seek, obtain, and understand health information in a solitary void [...].
Collapse
Affiliation(s)
- Joy Agner
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA;
| | - Katharine Elizabeth Bau
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA;
| | - Dirk Bruland
- Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences and Arts, Interaktion 1, 33619 Bielefeld, Germany;
| |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
Harzheim L, Lorke M, Rostamzadeh A, Jessen F, Woopen C, Jünger S. The Promotion of Health Literacy. GEROPSYCH 2023. [DOI: 10.1024/1662-9647/a000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Abstract: Progress in predictive medicine has increased the challenges to navigating complex risk information for patients and healthcare professionals. This contribution investigates how people facing the risk of developing Alzheimer’s dementia perceive risk, what aspects are relevant to their health literacy, and how to promote individual health literacy in predictive medicine. We conducted a qualitative study analyzing narrative interviews, body maps, and sociodemographic data from persons who had undergone early predictive procedures in a memory clinic. We understand the promotion of health literacy as an ethical task in predictive medicine and argue for (1) emphasizing personal resources to promote subjective health literacy, (2) reframing communication and decision-making about disease risk, and (3) teaching skills for value-sensitive, individualized risk communication.
Collapse
|
8
|
Oyeyemi DM, Omer ZB, Brown B, Freimund J, Gummerson C, Rink A, Gallant N, Marottoli RA. Developing an animated COVID-19 e-curriculum for adults with dementia and caregivers: Challenges and solutions. PATIENT EDUCATION AND COUNSELING 2023; 106:180-187. [PMID: 36371243 PMCID: PMC9597565 DOI: 10.1016/j.pec.2022.10.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 10/14/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Effective education and support for adults with dementia and their caregivers around pandemic issues is critical for protecting them. Animation-based learning has shown promise in patient education. We collaborated with educators and support staff at Alzheimer's Association Connecticut (AACT) to conduct a mixed-methods study and develop an animated e-curriculum addressing pandemic related challenges. METHODS We conducted focus groups and surveys with dementia and caregiver educators and support staff at AACT for the initial needs assessment and the later e-curriculum evaluation. An interdisciplinary team of educators followed a step-wise process to transform the needs assessment results into an animation based e-curriculum. RESULTS Participants identified the following pandemic challenges: 1) social isolation, 2) caregiver fatigue, 3) safety, and 4) difficulty navigating the healthcare system. The overall quality and usefulness of the e-curriculum was "very good" or "excellent". CONCLUSIONS An animated e-curriculum addressing pandemic related issues relevant to adults with dementia and caregivers had positive reviews and was associated with improvement in self-reported ability to perform curriculum objectives among community dementia educators. PRACTICE IMPLICATIONS The pandemic challenges identified may facilitate the development of further resources. Additionally, this project may serve as a guide for clinicians interested in incorporating animation into education efforts.
Collapse
Affiliation(s)
- Deborah M Oyeyemi
- Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Zehra B Omer
- Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, CT, USA; Department of Geriatrics & Extended Care, VA Connecticut Healthcare System, West Haven, CT, 06516, USA.
| | - Bryan Brown
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jennifer Freimund
- Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Christine Gummerson
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Andrea Rink
- Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Noelle Gallant
- Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Richard A Marottoli
- Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, CT, USA; Department of Geriatrics & Extended Care, VA Connecticut Healthcare System, West Haven, CT, 06516, USA
| |
Collapse
|
9
|
Shoji T, Fujii Y, Tateoka K, Tsuji T, Okura T. The association of the Japan Science and Technology Agency Index of Competence with physical and cognitive function in community‐dwelling older adults. Geriatr Gerontol Int 2022; 22:753-758. [DOI: 10.1111/ggi.14448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/23/2022] [Accepted: 07/12/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Takuro Shoji
- Graduate School of Comprehensive Human Sciences, Doctoral Program in Public Health University of Tsukuba Tsukuba Japan
| | - Yuya Fujii
- Physical Fitness Research Institute Meiji Yasuda Life Foundation of Health and Welfare Hachioji Japan
| | - Korin Tateoka
- Graduate School of Comprehensive Human Sciences, Doctoral Program in Physical Education, Health and Sport Sciences University of Tsukuba Tsukuba Japan
| | - Taishi Tsuji
- Faculty of Health and Sport Sciences University of Tsukuba Tsukuba Japan
| | - Tomohiro Okura
- Faculty of Health and Sport Sciences University of Tsukuba Tsukuba Japan
| |
Collapse
|
10
|
Chen P, Callisaya M, Wills K, Greenaway T, Winzenberg T. Cognition, educational attainment and diabetes distress predict poor health literacy in diabetes: A cross-sectional analysis of the SHELLED study. PLoS One 2022; 17:e0267265. [PMID: 35442990 PMCID: PMC9020687 DOI: 10.1371/journal.pone.0267265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 04/05/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives
To identify factors that predict poor health literacy amongst people with diabetes.
Design
Cross-sectional analysis of baseline data from a prospective study of diabetic foot disease.
Setting
Patients attending a tertiary hospital diabetes outpatient clinic in Tasmania, Australia.
Participants
222 people with diabetes mellitus, aged >40 years, with no history of foot ulceration, psychotic disorders or dementia.
Outcome measures
Health literacy was measured using the short form Test of Functional Health Literacy in Adults (functional health literacy), and the Health Literacy Questionnaire (HLQ), which measures nine domains of health literacy. Predictors included demographic characteristics, cognition, diabetes distress, depression, and educational attainment.
Results
In multivariable analysis, greater educational attainment (OR 0.88, 95% CI 0.76, 0.99) and poorer cognition (OR 0.71, 95% CI 0.63, 0.79) were associated with poorer functional health literacy. Age was negatively associated with domains of appraisal of health information and ability to find good health information (both beta = -0.01). Educational attainment was positively associated with four domains, namely having sufficient information to manage my health, actively managing my health, appraisal of and ability to find good health information (beta ranging from +0.03 to 0.04). Diabetes distress was negatively associated with five domains: having sufficient information to manage my health, social support for health, ability to actively engage with healthcare providers, navigating the healthcare system and ability to find good health information (beta ranging from -0.14 to -0.18).
Conclusion
Poorer cognition and poorer educational attainment may be detrimental for an individual’s functional health literacy, and education, diabetes distress and older age detrimental across multiple health literacy domains. Clinicians and policy makers should be attuned to these factors when communicating with people with diabetes and in designing healthcare systems to be more health-literacy friendly in order to improve diabetes outcomes.
Collapse
Affiliation(s)
- Pamela Chen
- School of Medicine, University of Tasmania, Hobart, Australia
- * E-mail:
| | - Michele Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Karen Wills
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | | | - Tania Winzenberg
- School of Medicine, University of Tasmania, Hobart, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| |
Collapse
|
11
|
Sullivan-Baca E, Babicz MA, Choudhury TK, Miller BI. The Relationship between Health Literacy and Comfort with Teleneuropsychology in a Veteran Sample. Arch Clin Neuropsychol 2022; 37:292-301. [PMID: 34599332 PMCID: PMC8500040 DOI: 10.1093/arclin/acab079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Health literacy is a strong psychosocial determinant of health disparities and has been found to relate to various aspects of health-related technology use. With the increased implementation of neuropsychological services performed via telehealth during the coronavirus disease 2019 pandemic, the relationship between health literacy and comfort with teleneuropsychology warrants further investigation. METHOD The present study examined 77 Veterans participating in neuropsychological evaluations as a part of standard clinical care. The sample was diverse in terms of age ethnicity, and psychiatric and neurocognitive diagnoses. In addition to a fixed-flexible neuropsychological battery, the Brief Health Literacy Screening Tool (BRIEF) was administered to evaluate health literacy. Self-reported comfort with the teleneuropsychological evaluation was assessed using an informal 10-point scale, and qualitative comfort responses were also recorded. RESULTS Independent samples t-tests revealed older adults were more likely to participate in the evaluation via telephone than with VA Video Connect. Although health literacy was not related to telehealth modality, it was correlated with comfort with the teleneuropsychological evaluation (r = .34, p < .01), although it is notable that average comfort levels were high across modalities (M = 8.16, SD = 2.50). CONCLUSIONS Findings support the notion that teleneuropsychological services may feasibly be implemented with a diverse group of patients, although flexibility with modality may be necessary. Those performing these services should also be aware that patients with lower health literacy may feel less comfortable with teleneuropsychology as they seek to build rapport and optimize evaluation engagement.
Collapse
Affiliation(s)
- Erin Sullivan-Baca
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Michelle A Babicz
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Tabina K Choudhury
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Brian I Miller
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
12
|
Rostamian S, le. Cessie S, Marijt KA, Jukema JW, Mooijaart SP, van Buchem MA, van Hall T, Gussekloo J, Trompet S. Association of cognitive function with increased risk of cancer death and all-cause mortality: Longitudinal analysis, systematic review, and meta-analysis of prospective observational studies. PLoS One 2022; 17:e0261826. [PMID: 34995287 PMCID: PMC8741047 DOI: 10.1371/journal.pone.0261826] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/12/2021] [Indexed: 11/29/2022] Open
Abstract
Background Disturbed cognitive function is associated with several causes of mortality; however, the association between cognitive function and the risk of cancer death has not been extensively investigated yet. We aimed to evaluate the association of cognitive function with the risk of cancer death and all-cause mortality in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) and Leiden 85-plus Study. Additionally, a systematic review and meta-analysis of longitudinal studies were conducted to evaluate the association of cognitive function and risk of cancer death. Methods Risk of cancer death and all-cause mortality were reported using hazard ratios (HRs) with 95% confidence interval (CI) in tertiles of cognitive function of PROSPER and Leiden85-Plus Study. Additionally, PubMed, Embase, Web of Science, Cochrane, PsycINFO, Academic Search Premier, CINHAL, and Emcare were searched up to November 1st, 2020 to perform a systematic review and meta-analysis. The relative risks (RRs) with 95%CI of cancer death per each standard deviation lower performance in cognitive measurements were calculated. Results Participants of PROSPER had 1.65-fold (95%CI 1.11–2.47) greater risk of cancer death (P for trend = 0.016) and 1.85-fold (95%CI 1.46–2.34) higher risk of all-cause mortality (P for trend<0.001), in multivariable models. Results of the Leiden-85 Plus Study showed that subjects with MMSE score below 24 had a lower chance of cancer death (HR 0.79, 95%CI 0.36–1.70, P for trend = 0.820) but had 2.18-fold (95%CI 1.57–3.02) higher risk of all-cause mortality compared to the reference group (P for trend<0.001). Besides, the results of systematic review and meta-analysis showed that per each standard deviation lower performance in cognitive function, individuals were at a 10% higher chance of cancer death (RR 1.10, 95%CI 1.00–1.20, P-value = 0.044). Conclusions Lower cognitive function performance is associated with a marginally increased risk of cancer death, in line with a significantly greater risk of all-cause mortality.
Collapse
Affiliation(s)
- Somayeh Rostamian
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Medicine, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Saskia le. Cessie
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Koen A. Marijt
- Department of Clinical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Simon P. Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Mark A. van Buchem
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Thorbald van Hall
- Department of Clinical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jacobijn Gussekloo
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Stella Trompet
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
- * E-mail:
| |
Collapse
|
13
|
Yu L, Mottola G, Bennett DA, Boyle PA. Adverse Impacts of Declining Financial and Health Literacy in Old Age. Am J Geriatr Psychiatry 2021; 29:1129-1139. [PMID: 33676832 PMCID: PMC8357843 DOI: 10.1016/j.jagp.2021.02.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/06/2021] [Accepted: 02/07/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Inadequate financial and health literacy presents a formidable public health and economic challenge in old age. This study investigated declining financial and health literacy in relation to decision making performance, scam susceptibility and psychological wellbeing. DESIGN Longitudinal study. SETTING A community-based cohort in Northeastern Illinois, USA. PARTICIPANTS One thousand fourty-six older adults who were free of dementia at baseline and underwent annual clinical and literacy assessments. MEASUREMENTS Financial and health literacy, decision making, scam susceptibility, and psychological wellbeing were assessed using validated instruments. Linear mixed effects models estimated person-specific rates of change in financial and health literacy, and multivariable regression analyses examined the associations of declining literacy with subsequent levels of decision making, scam susceptibility, and psychological wellbeing. RESULTS The mean age was 81 years and 76% were female. Over up to 10 years of annual follow-ups, the average financial and health literacy score dropped 1 percentage point a year. Substantial variability in decline was observed between participants. Faster decline in financial and health literacy was associated with poorer decision making, higher scam susceptibility, and lower psychological wellbeing. Notably, these associations were above and beyond the baseline literacy level and persisted even after controlling for cognition. CONCLUSIONS Most community-dwelling older adults experience decline in financial and health literacy over time, but decline is not inevitable. Declining literacy is related to poorer decision making, greater scam susceptibility and lower wellbeing. These findings suggest that efforts to mitigate declining financial and health literacy may promote independence and wellbeing in old age.
Collapse
Affiliation(s)
- Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center (LY, DAB, PAB), Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center (LY, DAB), Chicago, IL, USA.
| | - Gary Mottola
- FINRA Investor Education Foundation (GM), Washington DC, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center (LY, DAB, PAB), Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center (LY, DAB), Chicago, IL, USA
| | - Patricia A Boyle
- Rush Alzheimer's Disease Center, Rush University Medical Center (LY, DAB, PAB), Chicago, IL, USA; Department of Behavioral Sciences, Rush University Medical Center (PAB), Chicago, IL, USA
| |
Collapse
|
14
|
Ganguli M, Hughes TF, Jia Y, Lingler J, Jacobsen E, Chang CCH. Aging and Functional Health Literacy: A Population-based Study. Am J Geriatr Psychiatry 2021; 29:972-981. [PMID: 33349506 PMCID: PMC8197766 DOI: 10.1016/j.jagp.2020.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/23/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate functional health literacy and its associated factors among older adults drawn from a disadvantaged area. DESIGN Cross-sectional epidemiologic study. SETTING Population-based cohort randomly selected from the voter registration lists. PARTICIPANTS Individuals aged 65+ (N=1066). MEASUREMENTS The Short Test of Functional Health Literacy in Adults (S-TOFHLA); demographics; self-rated health; number of prescription drugs; modified Center for Epidemiologic Studies- Depression scale; Mini-Mental State Examination; Wechsler Test of Adult Reading; Clinical Dementia Rating; cognitive domain composite scores; independence in Instrumental Activities of Daily Living and medication management; health services utilization (emergency/urgent care visits and hospitalizations). RESULTS Low (inadequate or marginal) S-TOFHLA scores were obtained by 7.04% of the sample. In unadjusted analyses, participants with low S-TOFHLA scores were significantly more likely than those with higher scores to be older, male, non-White, with lesser education and lower household income, to have lower scores on the Wechsler Test of Adult Reading, the Mini-Mental State Examination, and all cognitive domains; to be more dependent in Instrumental Activities of Daily Living and be taking more prescription drugs. In a multiple regression model including all covariates, only older age, male sex, and lower reading level were independently associated with inadequate or marginal S-TOFHLA scores. CONCLUSION In a population-based sample of older adults, low functional health literacy was associated with age, sex, education, and reading ability. Basic functional health literacy is essential for understanding health information and instructions. Clinicians should formally or informally assess health literacy in their older patients to ensure effective communication and enhance health outcomes.
Collapse
Affiliation(s)
- Mary Ganguli
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
| | - Tiffany F. Hughes
- Department of Health Professions, Bitonte College of Health and Human Services, Youngstown State University, Youngstown, OH
| | - Yichen Jia
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Jennifer Lingler
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA,Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA,Clinical and Translational Science Institute, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Erin Jacobsen
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Chung-Chou H. Chang
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA,Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
15
|
O'Shea DM, Davis JD, Tremont G. Verbal memory is associated with adherence to COVID-19 protective behaviors in community dwelling older adults. Aging Clin Exp Res 2021; 33:2043-2051. [PMID: 34131881 PMCID: PMC8204921 DOI: 10.1007/s40520-021-01905-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/01/2021] [Indexed: 11/27/2022]
Abstract
Background Adherence to protective behaviors is central to limiting the spread of COVID-19 and associated risk of serious illness and mortality in older populations. Whether cognition predicts adherence to protective behaviors has not been examined in older adults. Aims To examine whether specific cognitive abilities predict adherence to COVID-19 protective behaviors in older adults, independent of other relevant factors. Methods Data from 431 older adults (i.e., ≥ 65 years) who took part in the COVID-19 module of the Health and Retirement Study were included in the present study. Separate binary logistic regression models were used to examine whether performance on measures of immediate and delayed recall and working memory predicted adherence to COVID-19 protective behaviors, controlling for demographics, level of COVID-19 concern, depressive symptoms, and medical conditions. Results For every unit increase in immediate and delayed recall, the probability of adhering to COVID-19 protective behaviors increased by 47% and 69%, respectively. There was no association between the measure of working memory and adherence. Discussion It is of public interest to understand the factors that reduce adherence to protective behaviors so that we can better protect those most vulnerable and limit community spread. Our findings demonstrate that reduced memory predicts non-adherence to COVID-19 protective behaviors, independent of virus concern, and other relevant demographic and health factors. Conclusions Public health strategies aimed at increasing adherence to COVID-19 protective behaviors in community dwelling older adults, should account for the role of reduced cognitive function in limiting adherence.
Collapse
Affiliation(s)
- Deirdre M O'Shea
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA.
| | - Jennifer D Davis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA
| | - Geoffrey Tremont
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA
| |
Collapse
|
16
|
Aging in Place with Age-Related Cognitive Changes: The Impact of Caregiving Support and Finances. SOCIETIES 2021. [DOI: 10.3390/soc11020031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In the United States, aging in place is a common concept that refers to older adults’ desire to remain in their homes as they age. However, this ability to age in place is a complex process that is not only impacted by the home’s accessibility or individual functional abilities. This paper aims to examine different factors, such as home environment and home modification, caregivers, finances, and other supports present in the participants’ lives, that impact older adults with age-related cognitive changes (ARCC) (in)ability to age in place. Qualitative interviews with older adults with ARCC (n = 5) and their caregivers (n = 5) were conducted. The participants’ experiences while aging in place indicate that finances and caregiving support greatly impacted their lives at home and ability to age in place. Personal finances dictated where some of the participants could age and the support, they could afford from home health aides. Additionally, informal and formal caregivers were an important source of support that aided in the older adults’ ability to remain home. As researchers, we need to continue to address personal finances and the support that the individual has in their lives to most effectively promote aging in place and their life at home.
Collapse
|
17
|
Abma LC, Timmermans RA, Yonker JE. Health congruence paradox in older adults: Contribution of cognition and relational visits. Geriatr Nurs 2021; 42:708-713. [PMID: 33831718 DOI: 10.1016/j.gerinurse.2021.02.015] [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: 01/04/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
The health congruence paradox can have important implications for those working with older adults as older adults' health understanding may be vague or directed toward health concerns other than those medically identified. Objective health was measured as diagnosed conditions from medical records. Two measures of subjective health were obtained through relational visits of university students, 1) health concerns older adults reported on a visit survey, 2) health concerns students reported during casual conversation. The results showed that community dwelling older adults with lower cognitive functioning ability were more susceptible to the health congruence paradox on the subjective measure of the survey report. Qualitative analysis of health concerns from subjective measures found older adults most concerned about health conditions impacting daily functioning, such as mobility and cognition, but not diagnosed hypertension. This mixed methods study confirmed the importance of understanding older adults' subjective health with measures easily obtained through relational visits with university students.
Collapse
|
18
|
Curtis LM, Kwasny MJ, Opsasnick L, O'Conor RM, Yoshino-Benavente J, Eifler M, Federman AD, Altschul D, Wolf MS. Change in Health Literacy over a Decade in a Prospective Cohort of Community-Dwelling Older Adults. J Gen Intern Med 2021; 36:916-922. [PMID: 33559068 PMCID: PMC8042084 DOI: 10.1007/s11606-020-06423-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 12/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Health literacy is often viewed as a static trait in longitudinal studies, which may over or underestimate an individual's ability to manage one's health. OBJECTIVES We sought to examine health literacy over time among older adults using three widely used measures. DESIGN A prospective cohort study. PARTICIPANTS Community-dwelling adults ages 55 to 74 at baseline with at least one follow-up visit (N = 656) recruited from one academic internal medicine clinic and six community health centers in Chicago, IL. MEASURES Health literacy was measured using the Test of Functional Health Literacy in Adults (TOFHLA), Newest Vital Sign (NVS), and Rapid Estimate of Adult Literacy in Medicine (REALM) at baseline and up to three follow-up time points. RESULTS In unadjusted analyses, significant changes since baseline were found beginning at the second follow-up (mean (M) = 6.0 years, SD = 0.6) for the TOFHLA (M = - 0.9, SD = 0.95, p = 0.049) and the REALM (M = 0.3, SD = 2.5, p = 0.004) and at the last follow-up (M = 8.6 years, SD = 0.5) for the NVS (M = - 0.2, SD = 1.4, p = 0.02). There were non-linear effects of baseline age on TOFHLA and NVS scores over time (piecewise cubic spline p = 0.01 and p < 0.001, respectively) and no effect on REALM scores (B = 0.02, 95% CI - 0.01 to 0.04, p = 0.17) using multivariable mixed-effects linear regression models, controlling for race, education, income, and comorbidity. CONCLUSION We found a negative relationship between age and health literacy over time as measured by the TOFHLA and NVS. Health literacy barriers appear to be more prevalent among individuals in later life, when self-care demands are similarly increasing. Clinicians might consider strategies to assess and respond to limited health literacy, particularly among patients 70 and older. REALM performance remained stable over 10 years of follow-up. This questions whether health literacy tools measure the same attribute. Prospective health literacy studies should carefully consider what measures to use, depending on their objective.
Collapse
Affiliation(s)
- Laura M Curtis
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA.
| | - Mary J Kwasny
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Lauren Opsasnick
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA
| | - Rachel M O'Conor
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA
| | - Julia Yoshino-Benavente
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA
| | - Morgan Eifler
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mt. Sinai, 17 East 102nd Street, 7th Floor, New York, NY, 10029, USA
| | - Drew Altschul
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Room F2, Psychology Building, 7 George Square, Edinburgh, EH8 9JZ, UK
| | - Michael S Wolf
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA
| |
Collapse
|
19
|
O'Connell ML, Coppinger T, Lacey S, Walton J, Arsenic T, McCarthy AL. Associations between Food Group Intake and Physical Frailty in Irish Community-Dwelling Older Adults. Nutr Metab Insights 2021; 14:11786388211006447. [PMID: 33854330 PMCID: PMC8013632 DOI: 10.1177/11786388211006447] [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: 10/19/2020] [Accepted: 03/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background Certain nutrients have shown protective effects against frailty, but less is known about the influence of individual food groups. Thus, this study aimed to investigate the relationship between the intake of different food groups and physical frailty in a cohort of community-dwelling older adults in Cork, Ireland. Methods One hundred and forty-two (n = 81 females, n = 61 males, age 74.1 ± 6.80 years) Irish community-dwelling volunteers aged ⩾65 years participated in this cross-sectional study. Dietary intake was assessed using a validated food frequency questionnaire (FFQ). Frailty was identified as having 3 or more of the following criteria: weight loss, exhaustion, weakness, slow walking speed and low physical activity. Relationships between intakes of food groups and frailty score were determined using Spearman's rank (and partial rank) correlations and ordinal logistic regression analysis. Results Negative Spearman's rank correlations were observed between frailty score and fish and fish products, fruit and vegetables and nuts and seeds, while positive correlations were found between frailty score and potatoes, fats and oils and sugars, preserves and snacks (P < .05). After adjustment for confounders, partial rank correlations remained statistically significant (P < .05) for all of the above dietary variables, with the exception of nuts and seeds (P > .05). Following ordinal logistic regression, the odds ratios (ORs) (95%CI) for frailty incidence for those in the lowest tertile of food group intake compared to the highest were; 3.04 (1.09-8.85) for fish and fish products, 4.34 (1.54-13.13) for fruit and vegetables, 1.52 (0.58-4.15) for nuts and seeds, 0.54 (0.19-1.51) for potatoes, 0.58 (0.17-1.95) for fats and oils and 0.49 (0.16-1.47) for sugars, preserves and snacks. Conclusion This study suggests that intakes of selected food groups are independently associated with frailty. These findings may hold significant relevance for the development of future frailty prevention strategies.
Collapse
Affiliation(s)
| | - Tara Coppinger
- Department of Sport, Leisure and Childhood Studies, Cork Institute of Technology, Cork, Ireland
| | - Seán Lacey
- Department of Mathematics, Cork Institute of Technology, Cork, Ireland
| | - Janette Walton
- Department of Biological Sciences, Cork Institute of Technology, Cork, Ireland
| | - Tijana Arsenic
- Department of Biological Sciences, Cork Institute of Technology, Cork, Ireland
| | | |
Collapse
|
20
|
Ysea-Hill O, Sani TN, Nasr LA, Gomez CJ, Ganta N, Sikandar S, Theou O, Ruiz JG. Concurrent Validity of Pictorial Fit-Frail Scale (PFFS) in Older Adult Male Veterans with Different Levels of Health Literacy. Gerontol Geriatr Med 2021; 7:23337214211003804. [PMID: 35047654 PMCID: PMC8762487 DOI: 10.1177/23337214211003804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction: Frailty is a state of vulnerability characterized by multisystemic physiological decline. The Pictorial Fit Frail Scale (PFFS) is a practical, image-based assessment that may facilitate the assessment of frailty in individuals with inadequate health literacy (HL). Objective: Determine the concurrent validity and feasibility of the PFFS in older Veterans with different levels of HL and cognition. Methods: Cross-sectional study in a geriatric clinic at a Veteran Health Administration (VHA) medical center. Veterans ≥65 years old completed a HL evaluation, PFFS, FRAIL scale and cognitive screening. We assessed the associations between PFFS, FRAIL scale, and VA-Frailty Index (VA-FI), and compared PFFS and FRAIL scale accuracy with a Receiver Operating Characteristic curve, Area Under the Curve (AUC) analysis, using the VA-FI as reference. Results: Eighty-three Veterans, mean age 76.20 (SD = 6.02) years, 65.1% Caucasian, 69.9% had inadequate HL, 57.8% were frail and 20.5% had cognitive impairment. All participants completed the 43 PFFS items. There were positive correlations between PFFS and VA-FI, r = .55 (95% CI: 0.365–0.735, p < .001), and FRAIL scale, r = .673 (95% CI: 0.509–0.836, p < .001). Compared to the VA-FI, the PFFS (AUC = 0.737; 95% CI: 0.629–0.844) and FRAIL scale (AUC = 0.724;95% CI: 0.615–0.824; p < .001) showed satisfactory diagnostic accuracy. Conclusions: The PFFS is valid and feasible in evaluating frailty in older Veterans with different levels of HL and cognition.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Olga Theou
- Dalhousie University, Halifax, NS, Canada
| | - Jorge G Ruiz
- Miami VA Healthcare System, FL, USA.,University of Miami Miller, FL, USA
| |
Collapse
|
21
|
Crespo TS, Andrade JMO, Lelis DDF, Ferreira AC, Souza JGS, Martins AMEDBL, Santos SHS. Adherence to medication, physical activity and diet among older people living with diabetes mellitus: Correlation between cognitive function and health literacy. IBRO Rep 2020; 9:132-137. [PMID: 33336106 PMCID: PMC7733141 DOI: 10.1016/j.ibror.2020.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023] Open
Abstract
Background Diabetes mellitus (DM) is a public health problem, which requires enhanced self-care in order to avoid complications. However, cognitive impairment can reduce these abilities and may affect health literacy (HL) of patients in terms to understand and apply information. Therefore, this study evaluated the correlation between cognitive condition and HL related to medication adherence, physical activity and nutritional status among people living with DM. Methods A cross-sectional study was carried out among elderly people (≥ 60 years old) with DM. The cognitive condition was evaluated using the Mini-Mental State Examination (MMSE) and the HL using the following questionnaires: Literacy Assessment for Diabetes (LAD-60), Nutritional Literacy among People with Diabetes (NLD), Health Literacy on the Practice of Physical Activities among Diabetics (HLPPA - D), and Health Literacy regarding Drug Adherence among Diabetics (HLDA-D). Sociodemographic and biochemical profile was also evaluated. Spearman correlation was used (p < 0.05). Results 187 individuals with DM were included. Regarding laboratory analyses, insulin dosage had a mean value of 12.3 microUI/mL (SD: ±15.7), mean blood glucose was 148.1 mg/dl (SD: ±59.7) and mean HbA1c was 7.54 % (SD: ±1.8). In the correlation analysis, higher age and lower income were weakly correlated with lower cognitive level. No correlation was identified for biochemical variables and cognitive condition. A positive and weak correlation between cognition and HL was observed in the studied population. Conclusions In older people living with DM the cognitive condition is correlated to specific topics of HL (nutritional status, physical activity and medication adherence).
Collapse
Affiliation(s)
- Thaísa Soares Crespo
- Laboratory of Health Sciences, Montes Claros State University, Montes Claros, Minas Gerais, Brazil.,Department of Physiopathology, Center of Health and Biological Sciences, Montes Claros State University, Montes Claros, Minas Gerais, Brazil
| | - João Marcus Oliveira Andrade
- Laboratory of Health Sciences, Montes Claros State University, Montes Claros, Minas Gerais, Brazil.,Department of Nursing, Center of Health and Biological Sciences, Montes Claros State University, Montes Claros, Minas Gerais, Brazil
| | - Deborah de Farias Lelis
- Laboratory of Health Sciences, Montes Claros State University, Montes Claros, Minas Gerais, Brazil
| | - Alice Crespo Ferreira
- Laboratory of Health Sciences, Montes Claros State University, Montes Claros, Minas Gerais, Brazil
| | | | - Andréa Maria Eleutério de Barros Lima Martins
- Laboratory of Health Sciences, Montes Claros State University, Montes Claros, Minas Gerais, Brazil.,Department of Dentistry, Center of Health and Biological Sciences, Montes Claros State University, Montes Claros, Minas Gerais, Brazil
| | - Sérgio Henrique Sousa Santos
- Laboratory of Health Sciences, Montes Claros State University, Montes Claros, Minas Gerais, Brazil.,Department of Dentistry, Center of Health and Biological Sciences, Montes Claros State University, Montes Claros, Minas Gerais, Brazil.,Institute of Agricultural Sciences. Food Engineering College, Federal University of Minas Gerais (UFMG), Montes Claros, Minas Gerais, Brazil
| |
Collapse
|
22
|
Fazeli PL, Woods SP, Lambert CC, Waldrop-Valverde D, Vance DE. Neurocognitive Functioning is Associated with Self-Reported and Performance-Based Treatment Management Abilities in People Living with HIV with Low Health Literacy. Arch Clin Neuropsychol 2020; 35:517-527. [PMID: 32090235 DOI: 10.1093/arclin/acaa005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/27/2019] [Accepted: 01/13/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE People living with HIV (PLWH) are at higher risk for poorer neurocognitive functioning and health literacy than uninfected persons, which are associated with worse medical outcomes. Aging research suggests that the effect of neurocognitive functioning on health outcomes may be more pronounced in those with low health literacy. We aimed to determine whether low health literacy might amplify the adverse effects of neurocognitive functioning on treatment management outcomes in 171 PLWH aged 40+. METHOD In this cross-sectional, observational study, participants completed a well-validated battery of neurocognitive, health literacy, and treatment management measures. A binary health literacy variable (low vs. adequate) was determined via established cut points on the well-validated health literacy tests. Treatment management outcomes included biomarkers of HIV (i.e., CD4 counts and viral load), self-management of HIV disease (i.e., self-reported medication adherence and self-efficacy for HIV disease management), and performance-based health-related decision-making. RESULTS Forty-seven percent of the sample met the criteria for low health literacy. Multivariable regressions adjusting for clinicodemographic (e.g., race, socioeconomic status) covariates revealed significant interactions for self-efficacy for HIV disease management and health-related decision-making, such that neurocognitive functioning was associated with these outcomes among those with low, but not adequate health literacy. CONCLUSIONS Findings suggest that low health literacy may increase the vulnerability of PLWH to the adverse effects of neurocognitive impairment on health outcomes, or conversely that adequate health literacy may provide a buffer against the health risks associated neurocognitive impairment. Interventions targeting health literacy in PLWH may mitigate the effects of neurocognitive impairment on health outcomes.
Collapse
Affiliation(s)
- Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
23
|
Slesinger NC, Yost KJ, Choi SW, Hahn EA. Validation of a Short Form for Health Literacy Assessment Using Talking Touchscreen Technology. Health Lit Res Pract 2020; 4:e200-e207. [PMID: 33034662 PMCID: PMC7544526 DOI: 10.3928/24748307-20200909-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/04/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Health literacy is an area of growing research and clinical interest, necessitating short, accurate measures of this complex construct. Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT) measures prose, document, and quantitative literacy by self-administration on a touchscreen computer. OBJECTIVE The objective of this study was to assess the validity of a short form of Health LiTT and to identify a meaningful cutoff score for adequate health literacy. METHODS A subsample of 137 participants from the Literacy and Cognitive Function among Older Adults study completed a 10-item Health LiTT short form and three interviewer-administered health literacy measures: Test of Functional Health Literacy in Adults (TOFHLA), Rapid Estimate of Adult Literacy in Medicine (REALM), and Newest Vital Sign (NVS). Convergent validity was assessed by correlating scores for all measures, and known-groups validity was assessed by comparing mean Health LITT scores across TOFHLA levels (inadequate, marginal, adequate). Internal consistency reliability was estimated with Cronbach's alpha. A cutoff score for adequate health literacy was established using the TOFHLA cutoff for adequate versus inadequate/marginal health literacy. KEY RESULTS Spearman correlations between Health LiTT scores and total TOFHLA, REALM, and NVS scores were 0.65, 0.69, and 0.56, respectively (all p < .001). Mean Health LiTT scores were significantly and meaningfully different across inadequate (40.4), marginal (50.1), and adequate (57.1) TOFHLA categories (F = 60.6; p < .001). Cronbach's alpha for the Health LiTT short form was .73. A cutoff score of 55 on Health LiTT showed acceptable sensitivity and specificity to identify adequate health literacy. CONCLUSIONS This 10-item Health LiTT short form demonstrated excellent convergent and known-groups validity and acceptable internal consistency reliability in older adults. The established cutoff also showed excellent sensitivity and specificity. Validation of other custom Health LiTT short forms with varying items from the bank and computer adaptive test-generated Health LiTT scores is ongoing. [HLRP: Health Literacy Research and Practice. 2020;4(4):e200-e207.] PLAIN LANGUAGE SUMMARY: This article provides evidence of the need for and psychometric properties of a valid and reliable short form of the flexible, technologically advanced Health Literacy Assessment Using Talking Touchscreen Technology measure, as well as a cutoff score to note adequate versus marginal/inadequate health literacy.
Collapse
Affiliation(s)
- Noël C. Slesinger
- Address correspondence to Noël C. Slesinger, MS, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 2700, Chicago, IL 60611;
| | | | | | | |
Collapse
|
24
|
Anami K, Murata S, Nakano H, Nonaka K, Iwase H, Shiraiwa K, Abiko T, Goda A, Horie J. The Association between Health Literacy and Gait Speed in Community-Dwelling Older Adults. Healthcare (Basel) 2020; 8:healthcare8040369. [PMID: 32998262 PMCID: PMC7712768 DOI: 10.3390/healthcare8040369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/24/2020] [Indexed: 01/19/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Kunihiko Anami
- Department of Rehabilitation, Faculty of Health Sciences, Naragakuen University, Nara 631-8524, Japan;
- Correspondence: ; Tel.: +81-742-93-5427
| | - Shin Murata
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto 607-8175, Japan; (S.M.); (H.N.); (K.S.); (T.A.); (A.G.); (J.H.)
| | - Hideki Nakano
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto 607-8175, Japan; (S.M.); (H.N.); (K.S.); (T.A.); (A.G.); (J.H.)
| | - Koji Nonaka
- Department of Rehabilitation, Faculty of Health Sciences, Naragakuen University, Nara 631-8524, Japan;
| | - Hiroaki Iwase
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe International University, Kobe 658-0032, Japan;
| | - Kayoko Shiraiwa
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto 607-8175, Japan; (S.M.); (H.N.); (K.S.); (T.A.); (A.G.); (J.H.)
| | - Teppei Abiko
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto 607-8175, Japan; (S.M.); (H.N.); (K.S.); (T.A.); (A.G.); (J.H.)
| | - Akio Goda
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto 607-8175, Japan; (S.M.); (H.N.); (K.S.); (T.A.); (A.G.); (J.H.)
| | - Jun Horie
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto 607-8175, Japan; (S.M.); (H.N.); (K.S.); (T.A.); (A.G.); (J.H.)
| |
Collapse
|
25
|
Muellers KA, Chen L, O'Conor R, Wolf MS, Federman AD, Wisnivesky JP. Health Literacy and Medication Adherence in COPD Patients: When Caregiver Presence Is Not Sufficient. COPD 2020; 16:362-367. [PMID: 31755323 DOI: 10.1080/15412555.2019.1665007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Limited health literacy (HL) is associated with a lower medication adherence in patients with chronic obstructive pulmonary disease (COPD). In this study, we examined the potential mitigating role of caregiver support on the relationship between HL and adherence to COPD medications. We conducted a prospective observational study of adults with COPD and their caregivers. HL was assessed using the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and COPD medication adherence was evaluated with the Medication Adherence Rating Scale (MARS). We also collected caregiver HL data for a subset of participants. We tested whether having a caregiver impacted the relationship between HL and medication adherence using cross-sectional data collected between 2011 and 2015. Our sample included 388 COPD patients and 97 caregivers. COPD patients with low HL had a lower medication adherence (odds ratio [OR]: 0.44, 95% confidence interval [CI]: 0.24-0.81) after adjusting for sociodemographic factors. Caregiver presence was not associated with increased patient medication adherence (OR: 1.28, 95% CI: 0.79-2.08). Among the subset of patients with caregivers, low patient HL remained associated with a lower medication adherence (OR: 0.28, 95% CI: 0.09-0.82) when adjusted for caregiver HL and sociodemographic factors. Low HL is associated with lower COPD medication adherence, and this effect is not mitigated by the presence of a caregiver. These findings suggest a need for effective strategies to manage high-risk COPD patients with low HL, even among those with adequate support from caregivers, and to design interventions for both patients and caregivers with low HL.
Collapse
Affiliation(s)
- Kimberly A Muellers
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Li Chen
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
26
|
Kalisch Ellett LM, Pratt NL, Nguyen TA, Roughead EE. Use of health and support services by people living with dementia in the community setting. Australas J Ageing 2020; 39:341-349. [DOI: 10.1111/ajag.12801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Lisa M. Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences University of South Australia Adelaide SA Australia
| | - Nicole L. Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences University of South Australia Adelaide SA Australia
| | - Tuan A. Nguyen
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences University of South Australia Adelaide SA Australia
| | - Elizabeth E. Roughead
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences University of South Australia Adelaide SA Australia
| |
Collapse
|
27
|
Maduka DO, Swanson MR, Markey K, Anderson BJ, Tracy M, Manganello JA. Health Literacy Among In-Care Older HIV Diagnosed Persons with Multimorbidity: MMP NYS (Excluding NYC). AIDS Behav 2020; 24:1092-1105. [PMID: 31435885 DOI: 10.1007/s10461-019-02627-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Older persons living with diagnosed HIV (PLWDH) are also at risk for age-related chronic conditions. With conflicting results on studies assessing health literacy and durable viral suppression, this study is the first in assessing this relationship using representative data on older in-care HIV-diagnosed persons with multimorbidity. Weighted data collected 2009-2014 from the Medical Monitoring Project (MMP) was used. Health literacy was assessed using the three-item Brief Health Literacy Screen (BHLS). The mean health literacy score was 11.22 (95% CI 10.86-11.59), and the mean multimorbidity was 4.75 (SE = 0.32). After adjusting, health literacy (OR 0.87, 95% CI 0.77-0.99) was found to be significantly associated with durable viral suppression. Adequate health literacy can help with achieving durable viral suppression. For these persons, addressing health literacy might increase their ability to access and navigate the healthcare system, thereby helping them stay engaged and maintain adherence to HIV care.
Collapse
|
28
|
Li SJ, Yin YT, Cui GH, Xu HL. The Associations Among Health-Promoting Lifestyle, eHealth Literacy, and Cognitive Health in Older Chinese Adults: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072263. [PMID: 32230935 PMCID: PMC7178131 DOI: 10.3390/ijerph17072263] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/12/2020] [Accepted: 03/24/2020] [Indexed: 12/03/2022]
Abstract
Background: Healthy lifestyles and health literacy are strongly associated with cognitive health in older adults, however, it is unclear whether this relationship can be generalized to health-promoting lifestyles and eHealth literacy. To date, no research has examined the interactive effect of health-promoting lifestyles and eHealth literacy on cognitive health. Objective: To examine the associations among health-promoting lifestyles, eHealth literacy, and cognitive health in older adults. Methods: Using a stratified cluster sampling method, we conducted a survey with older adults in four districts and two counties in Jinan (China). Older adults (n = 1201; age ≥ 60 years) completed our survey. We assessed health-promoting lifestyles, eHealth literacy, and cognitive health, and collected participants’ sociodemographic information. Results: Health-promoting lifestyles and eHealth literacy were significantly and positively associated with cognitive health (both p < 0.01). In addition, eHealth literacy was positively associated with health-promoting lifestyles. Moreover, the interaction of health-promoting lifestyle and eHealth literacy negatively predicted cognitive health (β = −0.465, p < 0.01). Conclusions: Health-promoting lifestyles and eHealth literacy were associated with the cognitive health of Chinese older adults, both independently and interactively. Further, eHealth literacy was associated with health-promoting lifestyles in older adults. Therefore, interventions regarding healthy lifestyles and eHealth literacy would benefit older adults.
Collapse
Affiliation(s)
- Shao-Jie Li
- Department of Social Medicine and Health Service Management, Xiangya School of Public Health, Central South University, Changsha 410078, China;
| | - Yong-Tian Yin
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan 250355, China;
| | - Guang-Hui Cui
- School of Acupuncture and Tuina, Shandong University of Traditional Chinese Medicine, Jinan 250355, China;
| | - Hui-Lan Xu
- Department of Social Medicine and Health Service Management, Xiangya School of Public Health, Central South University, Changsha 410078, China;
- Correspondence: ; Tel.: +86-136-3748-0958
| |
Collapse
|
29
|
Norris J. Cognitive Function in Cardiac Patients: Exploring the Occupational Therapy Role in Lifestyle Medicine. Am J Lifestyle Med 2020; 14:61-70. [PMID: 31903085 PMCID: PMC6933569 DOI: 10.1177/1559827618757189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 12/20/2017] [Accepted: 01/15/2018] [Indexed: 02/06/2023] Open
Abstract
Patients with cardiac dysfunction are at increased risk of mild cognitive impairment, which can affect their ability to successfully engage in daily activities important for home and community safety and in maintaining health and well-being. This risk increases in accordance with the number of cardiac conditions and cardiovascular risk factors or comorbidities. Occupational therapy has a role in chronic disease management in assessing and improving functional abilities affected by physical, emotional, and cognitive domains. With a holistic and client-centered approach, occupational therapy can complement lifestyle medicine principles through promotion and enablement of engagement in purposeful activity and self-management practices. It is suggested that the clinical management of patients with cardiac dysfunction expands beyond the traditional physical aspects of care to encompass cognitive considerations and incorporate occupational therapy in practice.
Collapse
Affiliation(s)
- Jennifer Norris
- Tamworth Rural Referral Hospital, New South Wales,
Australia
| |
Collapse
|
30
|
Liu YB, Chen YL, Xue HP, Hou P. Health Literacy Risk in Older Adults With and Without Mild Cognitive Impairment. Nurs Res 2019; 68:433-438. [PMID: 31693548 PMCID: PMC6845310 DOI: 10.1097/nnr.0000000000000389] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The relationship between an increasing elderly population and wide-ranging neurological conditions has led to heightened rates of cognitive function impairment. Some researchers have found that health literacy risk may be associated with cognitive impairment in older adults. OBJECTIVES The purpose of this study was to delineate the difference in health literacy risk between older adults with mild cognitive impairment and those with normal cognitive function. METHODS We conducted a survey study to explore the health literacy risk in older adults with and without mild cognitive impairment. Data were collected from 412 subjects between 60 and 91 years of age (260 without and 152 with mild cognitive impairment) between June and December 2016 in China. Cognitive function was measured using the Mini-Mental Status Examination, Montreal Cognitive Assessment, Global Deterioration Scale, Activities of Daily Living, and Hamilton Depression Rating Scale. Health literacy was measured using the Chinese Citizen Health Literacy Questionnaire. RESULTS The scores of total health literacy and its three dimensions (basic health knowledge and mind, basic skills, and health lifestyle and behavior) were lower in those with mild cognitive impairment. Older adults with normal cognitive function had adequate or marginal health literacy levels, whereas those with mild cognitive impairment had marginal or inadequate health literacy levels. Using multiple logistic regression analysis, we found that health literacy risk, education level, age, marital status, and body mass index were independent risk factors for mild cognitive impairment. DISCUSSION These results suggest that low health literacy may be a predictor of mild cognitive impairment. Screening for lower health literacy risk should be included in multidimensional geriatric evaluation.
Collapse
Affiliation(s)
- Yong B Liu
- Yong B. Liu, PhD, RN, is Professor, University of Yangzhou School of Nursing, Jiangsu. Hui P. Xue, MSN, RN, is Research Assistant, University of Yangzhou School of Nursing, Yangzhou, Jiangsu, China. Ping Hou, MSN, RN, is Research Assistant, University of Yangzhou School of Nursing, Jiangsu, China. Yan L. Chen, MSN, RN, is Nurse-in-Charge, The First People' Hospital of Ningxia, Yinchuan, China
| | | | | | | |
Collapse
|
31
|
Bae JB, Han JW, Kwak KP, Kim BJ, Kim SG, Kim JL, Kim TH, Ryu SH, Moon SW, Park JH, Youn JC, Lee DY, Lee DW, Lee SB, Lee JJ, Jhoo JH, Kim KW. Impact of Mild Cognitive Impairment on Mortality and Cause of Death in the Elderly. J Alzheimers Dis 2019; 64:607-616. [PMID: 29914024 DOI: 10.3233/jad-171182] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) is a cognitive state that lies on the continuum between normal aging and dementia, and the prevalence of MCI is higher than dementia. However, the risk for mortality of people with MCI has been far less studied than that of people with dementia, and the population attributable risk percent (PAR%) of death attributable to MCI has not been estimated yet. OBJECTIVE To investigate the impact of MCI on mortality and the cause of death in the elderly, and to estimate the PAR% of deaths attributable to MCI. METHODS Data came from 7,315 elderly subjects aged ≥60 years without dementia from two cohort studies with diagnostic assessments of MCI at baseline. Deaths among participants were confirmed through the nationwide mortality database of Statistics Korea. RESULTS MCI increased the risk of mortality in a multivariate Cox proportional model adjusting for age, sex, education, smoking, alcohol drinking, chronic illness, depression, vascular components, and cohort (hazard ratio = 1.59, 95% confidence interval 1.30, 1.94). PAR% of death attributable to MCI was 10.7% for age 65-74 years, 16.0% for age 75-84 years, and 24.2% for age ≥85 years. In the elderly with MCI, mortality risks from cerebrovascular disease, respiratory disease, and external causes were higher than in the cognitively normal elderly. CONCLUSIONS Our results suggest that the mortality risk of MCI in Asian countries may be comparable to that in Western countries, and MCI can contribute to the death of the elderly as much as dementia.
Collapse
Affiliation(s)
- Jong Bin Bae
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea.,Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggido, Korea
| | - Ji Won Han
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea.,Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggido, Korea
| | - Kyung Phil Kwak
- Department of Psychiatry, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Bong Jo Kim
- Department of Psychiatry, Gyeongsang National University, School of Medicine, Jinju, Korea
| | - Shin Gyeom Kim
- Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jeong Lan Kim
- Department of Psychiatry, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Seung-Ho Ryu
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Korea
| | - Seok Woo Moon
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju, Korea
| | - Joon Hyuk Park
- Department of Neuropsychiatry, Jeju National University Hospital, Jeju, Korea
| | - Jong Chul Youn
- Department of Neuropsychiatry, Kyunggi Provincial Hospital for the Elderly, Korea
| | - Dong Young Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Dong Woo Lee
- Department of Neuropsychiatry, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Seok Bum Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Jung Jae Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Jin Hyeong Jhoo
- Department of Neuropsychiatry, Kangwon National University Hospital, Chuncheon, Korea
| | - Ki Woong Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea.,Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggido, Korea.,Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Korea
| |
Collapse
|
32
|
Weissberger GH, Han SD, Yu L, Barnes LL, Bennett DA, Boyle PA. Financial and health literacy discrepancies with cognition in older adults. Neuropsychology 2019; 33:975-985. [PMID: 31204814 DOI: 10.1037/neu0000565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Greater financial and health literacy are associated with better cognition; however, research suggests that some individuals exhibit differences, or discrepancies, in these abilities in old age. We investigated discrepancies between literacy and cognition and factors associated with such discrepancies in older adults without dementia. METHOD Participants (N = 714; Mage = 81.4; education: M = 15.4; 75.4% female; 5.2% non-White) from the Rush Memory and Aging Project completed cognitive assessments and a financial and health literacy measure that yielded a total literacy score. Participants were characterized into three groups: (a) total literacy scores that are more than one standard deviation (1 SD) above cognition (L > C), (b) total literacy scores falling more than 1 SD below cognition (L < C), and (c) total literacy within 1 SD of cognition (L = C). Logistic regressions were employed to investigate associations between demographic and psychosocial variables and discrepancy group status. RESULTS Of the 714 participants, 24% showed significant discrepancies. In fully adjusted models, in reference to the L = C group, male sex was associated with greater odds of being in the L > C group (odds ratio [OR] = 2.32, 95% CI [1.33, 4.03], p = .003) and lower odds of being in the L < C group (OR = 0.31, 95% CI [0.14, 0.66], p = .002), higher income was associated with lower odds of being in either discrepancy group (L < C OR = 0.87, 95% CI [0.79, 0.96], p = .004; L > C OR = 0.86, 95% CI [0.76, 0.96], p = .007), and higher trust was associated with lower odds of being in the L > C group (OR = 0.92, 95% CI [0.85, 0.99], p = .030). CONCLUSIONS Findings support literacy and cognition as partially dissociable constructs and highlight important factors associated with discrepancies between literacy and cognition. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | - Lei Yu
- Rush Alzheimer's Disease Center
| | | | | | | |
Collapse
|
33
|
Verney SP, Gibbons LE, Dmitrieva NO, Kueider AM, Williams MW, Meyer OL, Manly JJ, Sisco SM, Marsiske M. Health literacy, sociodemographic factors, and cognitive training in the active study of older adults. Int J Geriatr Psychiatry 2019; 34:563-570. [PMID: 30548889 PMCID: PMC6557659 DOI: 10.1002/gps.5051] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 12/09/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Health literacy is critical for understanding information from health-care providers and correct use of medications and includes the capacity to filter other information in navigating health care systems. Older adults with low health literacy exhibit more chronic health conditions, worse physical functioning, and poorer mental health. This study examined the relationship between sociodemographic variables and health literacy, and the impact of cognitive training on change in health literacy over 10 years in older adults. METHODS Participants (N = 2,802) aged 65 years and older completed assessments, including reading and numeracy health literacy items, as part of the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study. We evaluated baseline sociodemographic variables and change in health literacy over a 10-year period in individuals exposed to cognitive training in reasoning, processing speed, memory, or a no-contact control condition. RESULTS Age, sex, race, education level, and general cognitive functioning at baseline were all associated with baseline health literacy in older adults. Predictors of change in health literacy over the 10-year follow-up were age, race, education level, general cognitive functioning, and neighborhood income; disparities in health literacy because of race attenuated over time, while the effect of age increased over time. Health literacy was generally stable across the ACTIVE intervention groups over 10 years. CONCLUSIONS The present study showed important disparities in health literacy level and change over 10 years. Cognitive training did not significantly impact health literacy, suggesting that alternative approaches are needed to reduce the disparities.
Collapse
Affiliation(s)
- Steven P Verney
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Laura E Gibbons
- University of Washington, UW Medicine Memory and Brain Wellness Center Harborview Medical Center, Seattle, WA, USA
| | - Natalia O Dmitrieva
- Northern Arizona University, College of Social and Behavioral Sciences, Flagstaff, AZ, USA
| | - Alexandra M Kueider
- Department of Psychiatry and Behavioral Sciences, Duke University, Duke Institute for Brain Sciences, Durham, NC, USA
| | - Michael W Williams
- Johns Hopkins University School of Medicine, Department of Physical Medicine and Rehabilitation, Baltimore, MD, USA
| | - Oanh L Meyer
- Alzheimer's Disease Center Department of Neurology, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Jennifer J Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
| | | | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| |
Collapse
|
34
|
Liu XB, Ayatollahi Y, Yamashita T, Jaradat M, Shen JJ, Kim SJ, Lee YJ, Hwang J, Yeom H, Upadhyay S, Liu C, Choi H, Yoo JW. Health Literacy and Mortality in Patients With Heart Failure: A Systematic Review and Meta-Analysis. Res Gerontol Nurs 2018; 12:99-108. [PMID: 30540872 DOI: 10.3928/19404921-20181018-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/17/2018] [Indexed: 11/20/2022]
Abstract
Heart failure (HF) remains the most common diagnosis of hospital admission among U.S. adults. Although diagnosis and treatment have improved, mortality rates have not changed, and mortality risk remains high after hospitalization. The current researchers examined how limited health literacy is associated with mortality risk in adults with recent hospitalization due to decompensated HF. Researchers conducted a systematic literature search, selecting three cohort and three intervention studies. The fixed-effect model was used. From the three cohort studies, 2,858 study participants were analyzed. Among participants, limited health literacy was associated with higher all-cause mortality (pooled odds ratio = 2.95; 95% confidence interval [2.34, 3.72]; p < 0.01; I2 = 47.38%). However, none of the intervention studies showed an association between limited health literacy and cardiac (or all-cause) mortality. Future research should focus on the efficiency and safety of telehealth-based medicine in patients with HF, particularly those with limited health literacy. [Res Gerontol Nurs. 2019; 12(2):91-108.].
Collapse
|
35
|
Fawns-Ritchie C, Starr JM, Deary IJ. Health literacy, cognitive ability and smoking: a cross-sectional analysis of the English Longitudinal Study of Ageing. BMJ Open 2018; 8:e023929. [PMID: 30368451 PMCID: PMC6224719 DOI: 10.1136/bmjopen-2018-023929] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES We used logistic regression to investigate whether health literacy and cognitive ability independently predicted whether participants have ever smoked and, in ever smokers, whether participants still smoked nowadays. DESIGN Cross-sectional study. SETTING This study used data from Wave 2 (2004-05) of the English Longitudinal Study of Ageing, which is a cohort study of adults who live in England and who, at baseline, were aged 50 years and older. PARTICIPANTS 8734 (mean age=65.31 years, SD=10.18) English Longitudinal Study of Ageing participants who answered questions about their current and past smoking status, and completed cognitive ability and health literacy tests at Wave 2. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measures were whether participants reported ever smoking at Wave 2 and whether ever smokers reported still smoking at Wave 2. RESULTS In models adjusting for age, sex, age left full-time education and occupational social class, limited health literacy (OR=1.096, 95% CI 0.988 to 1.216) and higher general cognitive ability (OR=1.000, 95% CI 0.945 to 1.057) were not associated with reporting ever smoking. In ever smokers, limited compared with adequate health literacy was associated with greater odds of being a current smoker (OR=1.194, 95% CI 1.034 to 1.378) and a 1 SD higher general cognitive ability score was associated with reduced odds of being a current smoker (OR=0.878, 95% CI 0.810 to 0.951), when adjusting for age, sex, age left full-time education and occupational social class. CONCLUSIONS When adjusting for education and occupation variables, this study found that health literacy and cognitive ability were independently associated with whether ever smokers continued to smoke nowadays, but not with whether participants had ever smoked.
Collapse
Affiliation(s)
- Chloe Fawns-Ritchie
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - John M Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
36
|
Fawns-Ritchie C, Starr JM, Deary IJ. Role of cognitive ability in the association between functional health literacy and mortality in the Lothian Birth Cohort 1936: a prospective cohort study. BMJ Open 2018; 8:e022502. [PMID: 30206087 PMCID: PMC6144414 DOI: 10.1136/bmjopen-2018-022502] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/17/2018] [Accepted: 07/25/2018] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES We investigated the role that childhood and old age cognitive ability play in the association between functional health literacy and mortality. DESIGN Prospective cohort study. SETTING This study used data from the Lothian Birth Cohort 1936 (LBC1936) study, which recruited participants living in the Lothian region of Scotland when aged 70 years, most of whom had completed an intelligence test at age 11 years. PARTICIPANTS 795 members of the LBC1936 with scores on tests of functional health literacy and cognitive ability in childhood and older adulthood. PRIMARY AND SECONDARY OUTCOME MEASURES Participants were followed up for 8 years to determine mortality. Time to death in days was used as the primary outcome measure. RESULTS Using Cox regression, higher functional health literacy was associated with lower risk of mortality adjusting for age and sex, using the Shortened Test of Functional Health Literacy in Adults (HR 0.95, 95% CI 0.92 to 0.98), the Newest Vital Sign (HR 0.88, 95% CI 0.80 to 0.97) and a functional health literacy composite measure (HR 0.77, 95% CI 0.65 to 0.92), but not the Rapid Estimate of Adult Literacy in Medicine (HR 0.95, 95% CI 0.90 to 1.01). Adjusting for childhood intelligence did not change these associations. When additionally adjusting for fluid-type cognitive ability in older age, associations between functional health literacy and mortality were attenuated and non-significant. CONCLUSIONS Current fluid ability, but not childhood intelligence, attenuated the association between functional health literacy and mortality. Functional health literacy measures may, in part, assess fluid-type cognitive abilities, and this may account for the association between functional health literacy and mortality.
Collapse
Affiliation(s)
- Chloe Fawns-Ritchie
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - John M Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
37
|
Macha-Quillama LF, Samanamú-Leandro AE, Rodriguez-Hurtado DC. [Health literacy and associated factors in patients attending the Outpatient Internal Medicine Service of a national hospital of Lima, Peru]. ACTA ACUST UNITED AC 2018; 19:679-685. [PMID: 30183817 DOI: 10.15446/rsap.v19n5.53008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 05/28/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine health literacy in patients attending the Outpatient Internal Medicine Service of a national hospital of Lima, Peru, in March 2014 in order to establish factors associated with inadequate health literacy. MATERIALS AND METHODS Descriptive study. The Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50) was used after partial cultural validation. Expert opinion and measurement of the correlation coefficient were considered. Subsequently, the test was applied in a sample of 363 patients selected by simple systematic random sampling. RESULTS For partial cultural validation, 17 items of the original test were modified and a Pearson correlation coefficient of r=0.81 was obtained. After cultural validation, the test was applied, finding that 73.3 % were women, 14.0 % were seniors, and 52.6 % completed high school. Furthermore, 35.3 % were affiliated to health insurance subsidized by the government (Comprehensive Health Insurance or SIS by its acronym in Spanish). 15.20 % did not use any health service during the past year and 34.4 % had inadequate health literacy. Variables such as senior age, poor education, SIS insurance and fewer visits to health services within the past year have a significant association with inadequate levels of health literacy (p<0.05). CONCLUSIONS One third of patients attending the Outpatient Internal Medicine Service of the Hospital Nacional Arzobispo Loayza had inadequate health literacy. Variables such as senior age, poor education, SIS insurance and fewer visits to health services within the past year have a significant association with inadequate levels of health literacy.
Collapse
Affiliation(s)
- Luis F Macha-Quillama
- LM: MD. Facultad de Medicina Alberto Hurtado. Universidad Peruana Cayetano Heredia. Lima, Perú.
| | | | - Diana C Rodriguez-Hurtado
- DR: MD. Facultad de Medicina Alberto Hurtado. Universidad Peruana Cayetano Heredia. Hospital Nacional Arzobispo Loayza de Lima, Perú.
| |
Collapse
|
38
|
Stoicea N, Koehler K, Scharre D, Bergese S. Cognitive self-assessment scales in surgical settings: Acceptability and feasibility. Best Pract Res Clin Anaesthesiol 2018; 32:303-309. [DOI: 10.1016/j.bpa.2018.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/01/2018] [Accepted: 08/01/2018] [Indexed: 01/09/2023]
|
39
|
Piper SE, Bailey PE, Lam LT, Kneebone II. Predictors of mental health literacy in older people. Arch Gerontol Geriatr 2018; 79:52-56. [PMID: 30107312 DOI: 10.1016/j.archger.2018.07.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/11/2018] [Accepted: 07/14/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Older adults exhibit poorer mental health literacy than younger adults, including less accuracy at identifying symptoms of mental disorders, and endorsing fewer sources of treatment for a mental disorder. The current study's intention was to determine if the executive component of cognition is associated with mental health literacy in older adults, when controlling for other established predictors (sex, age, education, and proximity to someone with a mental disorder). METHOD The sample included 85 cognitively healthy adults aged 60 and over. Participants completed the Mini-Addenbrooke's Cognitive Examination III, the Trail Making Test, a Phonemic Verbal Fluency Test, and the Mental Health Literacy Scale. RESULTS A multiple regression indicated that age and mental health proximity significantly and uniquely predicted total mental health literacy (Age: β = -0.22, t = -2.04, p < 0.05; Proximity: β = 0.31, t = 2.78, p < 0.01). Older age predicted poorer PTSD mental health literacy (β = -0.31, t = -2.90, p < 0.01). CONCLUSION In neurologically healthy older adults, level of executive function did not contribute to mental health literacy. Older adults in closer proximity to someone with a mental disorder were more likely to have better mental health literacy, a finding that has the potential to inform mental health education and promotion strategies in this population.
Collapse
Affiliation(s)
- Sarah E Piper
- School of Social Sciences and Psychology, Western Sydney University, Australia; Brain and Mind Centre, The University of Sydney, Australia
| | - Phoebe E Bailey
- School of Social Sciences and Psychology, Western Sydney University, Australia
| | - Lawrence T Lam
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, PO Box 123, Ultimo, NSW, 2007, Australia
| | - Ian I Kneebone
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, PO Box 123, Ultimo, NSW, 2007, Australia.
| |
Collapse
|
40
|
Uemura K, Yamada M, Okamoto H. Effects of Active Learning on Health Literacy and Behavior in Older Adults: A Randomized Controlled Trial. J Am Geriatr Soc 2018; 66:1721-1729. [DOI: 10.1111/jgs.15458] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/26/2018] [Accepted: 04/24/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Kazuki Uemura
- Department of Liberal Arts and Sciences, Faculty of Engineering; Toyama Prefectural University; Imizu Japan
| | - Minoru Yamada
- Graduate School of Comprehensive Human Sciences; University of Tsukuba; Tokyo Japan
| | - Hiroshi Okamoto
- Department of Liberal Arts and Sciences, Faculty of Engineering; Toyama Prefectural University; Imizu Japan
| |
Collapse
|
41
|
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.
Collapse
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
| |
Collapse
|
42
|
Suh SW, Han JW, Park JY, Hong JW, Kim K, Kim T, Lee KH, Han G, Jeong H, Seo J, Kim TH, Lee DY, Lee DW, Ryu SH, Kim SG, Youn JC, Jhoo JH, Kim JL, Lee SB, Lee JJ, Kwak KP, Kim BJ, Moon SW, Park JH, Kim KW. Impacts of Illiteracy on the Risk of Dementia: A Global Health Perspective. J Alzheimers Dis 2018; 53:731-41. [PMID: 27232216 DOI: 10.3233/jad-160108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite its significance as a contributing factor for late-life dementia risk, illiteracy is frequently underappreciated in the management of dementia. In this study, we estimated the proportion of dementia cases attributable to illiteracy using the population attributable fraction (PAF), and calculated to what extent the monetary cost of dementia could be saved in the future by reducing illiteracy from the South Korean, Latin American, South Asian/Middle Eastern, and African populations. We collected necessary data from the 2011 United Nations Human Development Report and prevalence studies conducted in these regions. Additional variables not included in the above sources were estimated using a logit model under a "trend scenario"-based assumption. Around 16% of the total number of dementia cases in South Korea in 2015 can be attributed to illiteracy, with this figure predicted to decline to around 2% by 2050. This translates to a saving in dementia care costs of approximately 52 billion USD, providing we are successful in theoretically eradicating illiteracy as of 2015, in the population aged 65 years or under. Likewise, reducing illiteracy to 50% in Latin America, South Asia/The Middle East, and Africa by 2050 could generate further cost savings of between 71 and 244 billion, 13 and 94 billion, and 17 and 78 billion USD, respectively. Even public policies aimed solely at reducing illiteracy in the childhood, adolescent, or middle-aged population could potentially have a role in the primary prevention of dementia. Moving forward, governments will need to address this issue in a purposeful and systematic manner.
Collapse
Affiliation(s)
- Seung Wan Suh
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Young Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Woo Hong
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kayoung Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Taehyun Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyoung Hwan Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Guehee Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyeon Jeong
- Department of Psychiatry, Woori-Seongsim Psychiatric Clinic, Siheung, Korea
| | - Jiyeong Seo
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Korea
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Dong Young Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea.,Department of Psychiatry, Seoul National University, College of Medicine, Seoul, Korea
| | - Dong Woo Lee
- Department of Neuropsychiatry, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Seung-Ho Ryu
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Korea
| | - Shin-Gyeom Kim
- Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jong Chul Youn
- Department of Neuropsychiatry, Gyeonggi Provincial Hospital for the Elderly, Yongin, Korea
| | - Jin Hyeong Jhoo
- Department of Neuropsychiatry, Kangwon National University Hospital, Chuncheon, Korea
| | - Jeong Lan Kim
- Department of Psychiatry, Chungnam National University Hospital, Daejeon, Korea
| | - Seok Bum Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Jung Jae Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Kyung Phil Kwak
- Department of Psychiatry, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Bong-Jo Kim
- Department of Psychiatry, Gyeongsang National University, School of Medicine, Jinju, Korea
| | - Seok Woo Moon
- Department of Psychiatry, Konkuk University, School of Medicine, Chungju, Korea
| | - Joon Hyuk Park
- Department of Neuropsychiatry, Jeju National University Hospital, Jeju, Korea
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Psychiatry, Seoul National University, College of Medicine, Seoul, Korea.,Department of Brain and Cognitive Sciences, Seoul National University, College of Natural Sciences, Seoul, Korea
| |
Collapse
|
43
|
Rhee TG, Lee HY, Kim NK, Han G, Lee J, Kim K. Is Health Literacy Associated With Depressive Symptoms Among Korean Adults? Implications for Mental Health Nursing. Perspect Psychiatr Care 2017; 53:234-242. [PMID: 27198862 DOI: 10.1111/ppc.12162] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 01/31/2016] [Accepted: 02/19/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This study investigated whether health literacy is associated with depressive symptoms among Korean adults, when adjusting for relevant risk factors for depression. METHODS Data were collected from a sample of 585 community-dwelling Korean adults living in Seoul and Kwangju, South Korea, using a quota sampling strategy. A cross-sectional, multivariate regression analysis was used to investigate the association between health literacy and depressive symptoms. RESULTS When controlled for covariates, a lower level of health literacy was significantly associated with a higher level of depressive symptoms. CONCLUSION Health literacy may play an important role in preventing and treating depression. Future research is needed to determine if improving health literacy, through health promotion interventions, can enhance community-dwelling Korean adults' understanding of depressive symptoms and relevant treatment options.
Collapse
Affiliation(s)
- Taeho Greg Rhee
- PhD candidate, Department of Pharmaceutical Care and Health System, College of Pharmacy, University of Minnesota, Twin Cities, USA
| | - Hee Yun Lee
- Professor, School of Social Work, College of Education and Human Development, University of Minnesota, Twin Cities, USA
| | - Nam Keol Kim
- Admissions Officer, Pohang University of Science and Technology, Pohang, Korea, and PhD student, Department of Educational Psychology, College of Education and Human Development, University of Minnesota, Twin Cities, USA
| | - Gyounghae Han
- Professor, College of Human Ecology, Seoul National University, Seoul, Korea
| | - Jeonghwa Lee
- Associate Professor, Department of Family Environment and Welfare, Chonnam National University, Gwangju, Korea
| | - Kyoungwoo Kim
- Physician, Department of Family Medicine, Inje University Seoul Paik Hospital, Seoul, Korea
| |
Collapse
|
44
|
Johnson NX, Marquine MJ, Flores I, Umlauf A, Baum CM, Wong AWK, Young AC, Manly JJ, Heinemann AW, Magasi S, Heaton RK. Racial Differences in Neurocognitive Outcomes Post-Stroke: The Impact of Healthcare Variables. J Int Neuropsychol Soc 2017; 23:640-652. [PMID: 28660849 PMCID: PMC5703208 DOI: 10.1017/s1355617717000480] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The present study examined differences in neurocognitive outcomes among non-Hispanic Black and White stroke survivors using the NIH Toolbox-Cognition Battery (NIHTB-CB), and investigated the roles of healthcare variables in explaining racial differences in neurocognitive outcomes post-stroke. METHODS One-hundred seventy adults (91 Black; 79 White), who participated in a multisite study were included (age: M=56.4; SD=12.6; education: M=13.7; SD=2.5; 50% male; years post-stroke: 1-18; stroke type: 72% ischemic, 28% hemorrhagic). Neurocognitive function was assessed with the NIHTB-CB, using demographically corrected norms. Participants completed measures of socio-demographic characteristics, health literacy, and healthcare use and access. Stroke severity was assessed with the Modified Rankin Scale. RESULTS An independent samples t test indicated Blacks showed more neurocognitive impairment (NIHTB-CB Fluid Composite T-score: M=37.63; SD=11.67) than Whites (Fluid T-score: M=42.59, SD=11.54; p=.006). This difference remained significant after adjusting for reading level (NIHTB-CB Oral Reading), and when stratified by stroke severity. Blacks also scored lower on health literacy, reported differences in insurance type, and reported decreased confidence in the doctors treating them. Multivariable models adjusting for reading level and injury severity showed that health literacy and insurance type were statistically significant predictors of the Fluid cognitive composite (p<.001 and p=.02, respectively) and significantly mediated racial differences on neurocognitive impairment. CONCLUSIONS We replicated prior work showing that Blacks are at increased risk for poorer neurocognitive outcomes post-stroke than Whites. Health literacy and insurance type might be important modifiable factors influencing these differences. (JINS, 2017, 23, 640-652).
Collapse
Affiliation(s)
- Neco X Johnson
- 1San Diego State University,Department of Psychology,San Diego,California
| | - Maria J Marquine
- 2University of California,San Diego,Department of Psychiatry,San Diego,California
| | - Ilse Flores
- 1San Diego State University,Department of Psychology,San Diego,California
| | - Anya Umlauf
- 2University of California,San Diego,Department of Psychiatry,San Diego,California
| | - Carolyn M Baum
- 3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri
| | - Alex W K Wong
- 3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri
| | - Alexis C Young
- 3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri
| | | | - Allen W Heinemann
- 5Northwestern University,Feinberg School of Medicine,Department of Physical Medicine & Rehabilitation and Rehabilitation Institute of Chicago,Chicago,Illinois
| | - Susan Magasi
- 6University of Illinois at Chicago,Department of Occupational Therapy,Chicago,Illinois
| | - Robert K Heaton
- 2University of California,San Diego,Department of Psychiatry,San Diego,California
| |
Collapse
|
45
|
Cross-cultural adaptation and validation of the Newest Vital Sign (NVS) health literacy instrument in general population and highly educated samples of Brazilian adults. Public Health Nutr 2017; 20:1907-1913. [DOI: 10.1017/s1368980017000787] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveThe present work aimed at cross-cultural adaptation and validation of the health literacy assessment tool Newest Vital Sign (NVS) in general population (GP) and highly educated (HE) samples of Brazilian adults.DesignAn expert committee reviewed the translation and back-translation processes and the cultural adaptation. The construct validity was analysed with confirmatory factor analysis and via associations with features of the study population.SettingThe final validation test was performed in two different populations from Londrina, a large town in southern Brazil.SubjectsBrazilian adults: GP (adult clients of community pharmacies;n189) and HE (public school teachers;n301).ResultsThe tool under validation showed good cross-cultural adaptation and internal consistency, with Cronbach’sαof 0·75 for GP and 0·74 for HE. Confirmatory factor analysis showed acceptable models and identified two independent factors according to the relationship between components and numeracy for both GP and HE data. According to the Brazilian Portuguese version of the NVS instrument (NVS-BR), 48·7 % of GP and 33·5 % of HE presented adequate health literacy; this condition was inversely associated with age for both populations and directly correlated with educational level for GP.ConclusionsThe NVS-BR showed good validity in two different populations of Brazilian adults and can be considered an alternative in screening for inadequate health literacy.
Collapse
|
46
|
Rong H, Cheng X, Garcia JM, Zhang L, Lu L, Fang J, Le M, Hu P, Dong X, Yang J, Wang Y, Luo T, Liu J, Chen JA. Survey of health literacy level and related influencing factors in military college students in Chongqing, China: A cross-sectional analysis. PLoS One 2017; 12:e0177776. [PMID: 28545133 PMCID: PMC5435342 DOI: 10.1371/journal.pone.0177776] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 05/02/2017] [Indexed: 11/17/2022] Open
Abstract
Health literacy (HL) has become an important public health issue and is receiving growing attention. However, the HL levels of military college students in China have never been analyzed. This study aimed to investigate the HL and related associate factors in military college students in Chongqing, China. Data was obtained with the “Chinese Citizen Health Literacy Questionnaire (2012 edition)” from 3183 military college students aged 16–28 years at Chongqing in December 2015. A total score of ≥80 points determined adequate HL, and HL level was defined as the proportion of students who had adequate HL out of the total number of participants. Multiple logistic regression analysis with a stepwise forward likelihood ratio (LR) method was used to determine the effects of sociodemographic characteristics, health-related behaviors, and family-related factors on HL level. The mean score of HL was 68.56, and the HL level of military college students was 21.05%; the overall knowledge rate was 71.33%. The independent factors that were associated with HL level were years in college, educational system, time playing online games, annual household income and father's education level. Senior (odds ratio [OR] = 1.229, 95% confidence interval [CI] 1.018∼1.484), undergraduate (OR = 1.509, 95% CI 1.151∼1.978), time played games more than 5 hours each week (OR = 0.638, 95% CI 0.486∼0.837), annual household incomes more than 50,000 yuan (OR = 1.231, 95% CI 1.027∼1.476) and father's education level (high school: OR = 2.327, 95% CI 1.186∼4.565; university: OR = 2.450, 95% CI 1.244∼4.825), were independently associated with higher HL level. HL levels of military college students in Chongqing need to be improved across the board. Our data suggests that special emphasis should be placed on students in junior and those in the specialist educational system. School departments may also benefit from incorporating health literacy into their curricula and helping students manage the time they spend playing online games.
Collapse
Affiliation(s)
- Honghui Rong
- Department of Health Education, Third Military Medical University, Chongqing, China
| | - Xin Cheng
- Department of Health Education, Third Military Medical University, Chongqing, China
| | - Jose M Garcia
- GRECC, VA Puget Sound Health Care System and University of Washington, Seattle, WA, United States of America
| | - Ling Zhang
- Department of Health Education, Third Military Medical University, Chongqing, China
| | - Lu Lu
- Department of Health Education, Third Military Medical University, Chongqing, China
| | - Jian Fang
- Department of Ambulant Clinic, Institute of Communication of PLA, Chongqing, China
| | - Mingshan Le
- Department of Ambulant Clinic, Institute of Logistics Engineering of PLA, Chongqing, China
| | - Peng Hu
- Department of Ambulant Clinic, Institute of Communication of PLA, Chongqing, China
| | - Xinlu Dong
- Department of Ambulant Clinic, Institute of Communication of PLA, Chongqing, China
| | - Junli Yang
- Department of Ambulant Clinic, Institute of Logistics Engineering of PLA, Chongqing, China
| | - Ya Wang
- Department of Ambulant Clinic, Institute of Logistics Engineering of PLA, Chongqing, China
| | - Ting Luo
- Department of Health Education, Third Military Medical University, Chongqing, China
| | - Jun Liu
- Department of Health Education, Third Military Medical University, Chongqing, China
| | - Ji-An Chen
- Department of Health Education, Third Military Medical University, Chongqing, China
| |
Collapse
|
47
|
Chin J, Madison A, Gao X, Graumlich JF, Conner-Garcia T, Murray MD, Stine-Morrow EAL, Morrow DG. Cognition and Health Literacy in Older Adults' Recall of Self-Care Information. THE GERONTOLOGIST 2017; 57:261-268. [PMID: 26209450 PMCID: PMC5881765 DOI: 10.1093/geront/gnv091] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 06/01/2015] [Indexed: 11/13/2022] Open
Abstract
Purpose of the Study Health literacy is associated with health outcomes presumably because it influences the understanding of information needed for self-care. However, little is known about the language comprehension mechanisms that underpin health literacy. Design and Methods We explored the relationship between a commonly used measure of health literacy (Short Test of Functional Health Literacy in Adults [STOFHLA]) and comprehension of health information among 145 older adults. Results Results showed that performance on the STOFHLA was associated with recall of health information. Consistent with the Process-Knowledge Model of Health Literacy, mediation analysis showed that both processing capacity and knowledge mediated the association between health literacy and recall of health information. In addition, knowledge moderated the effects of processing capacity limits, such that processing capacity was less likely to be associated with recall for older adults with higher levels of knowledge. Implications These findings suggest that knowledge contributes to health literacy and can compensate for deficits in processing capacity to support comprehension of health information among older adults. The implications of these findings for improving patient education materials for older adults with inadequate health literacy are discussed.
Collapse
Affiliation(s)
- Jessie Chin
- Department of Educational Psychology and the Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign
| | - Anna Madison
- Department of Psychology and the Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana Champaign
| | - Xuefei Gao
- Department of Educational Psychology and the Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign
| | - James F Graumlich
- Department of Medicine, University of Illinois College of Medicine, Peoria
| | | | - Michael D Murray
- Department of Pharmacy, Purdue University, West Lafayette, Indiana
- Regenstrief Institute, Indianapolis, Indiana
| | - Elizabeth A L Stine-Morrow
- Department of Educational Psychology and the Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign
| | - Daniel G Morrow
- Department of Educational Psychology and the Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign
| |
Collapse
|
48
|
Hahn EA, Magasi SR, Carlozzi NE, Tulsky DS, Wong A, Garcia SF, Lai JS, Hammel J, Miskovic A, Jerousek S, Goldsmith A, Nitsch K, Heinemann AW. Health and Functional Literacy in Physical Rehabilitation Patients. Health Lit Res Pract 2017; 1:e71-e85. [PMID: 31294252 PMCID: PMC6607848 DOI: 10.3928/24748307-20170427-02] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/05/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND People with disabilities, who face multiple barriers to care, experience health disparities, yet few studies have measured health literacy in this population. OBJECTIVE This study evaluated functional literacy, health literacy, fluid cognitive function, and self-reported health in people who live in community dwellings with spinal cord injury, stroke, or traumatic brain injury. METHODS Participants with a traumatic spinal cord injury, stroke, or traumatic brain injury, one-year postinjury, and age 18 to 85 years, completed a battery of instruments at three medical centers in the Midwestern U.S.: functional literacy (word recognition, vocabulary knowledge), health literacy (comprehension of prose, document, and quantitative health information), fluid cognitive function (memory, executive function, and processing speed), and patient-reported outcomes (mobility, fatigue, sadness, anxiety, social function, and overall health). KEY RESULTS There were strong correlations between functional literacy, health literacy, and fluid cognitive function. After adjustment for sociodemographic and clinical characteristics, higher health literacy was associated with better mobility, less anxiety, and better overall health; higher functional literacy was associated with less anxiety and better overall health; and higher fluid cognitive function was associated with better mobility, less sadness, better social function, and better overall health. CONCLUSIONS To effectively address limited health literacy among people with spinal cord injury, stroke, and traumatic brain injury, and ensure that they are able to be informed partners in their health care, intervention is required at the level of patients, providers, and health care delivery systems. A special consideration is to ensure that health information is both well-targeted to people's health literacy levels and accessible for people with a range of physical, cognitive, and sensory limitations. The multimedia self-administered health literacy measure used in this study could be useful to rehabilitation providers and designers of health information and interfaces. [Health Literacy Research and Practice. 2017;1(2):e71-e85.]. PLAIN LANGUAGE SUMMARY Health literacy represents people's abilities to obtain, understand, and use health information to make informed decisions about their health and health care. People with disabilities face physical, attitudinal, economic, and structural barriers to care. Consideration of health literacy in rehabilitation practice can enhance the effectiveness of the patient-clinician relationship and help address the needs of this population.
Collapse
Affiliation(s)
- Elizabeth A. Hahn
- Address correspondence to Elizabeth A. Hahn, MA, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N. Saint Clair Street, Suite 1900, Chicago, IL 60611;
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Howell EH, Senapati A, Hsich E, Gorodeski EZ. Medication self-management skills and cognitive impairment in older adults hospitalized for heart failure: A cross-sectional study. SAGE Open Med 2017; 5:2050312117700301. [PMID: 28540048 PMCID: PMC5433792 DOI: 10.1177/2050312117700301] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 02/15/2017] [Indexed: 01/07/2023] Open
Abstract
Background: Cognitive impairment is highly prevalent among older adults (aged ≥65 years) hospitalized for heart failure and has been associated with poor outcomes. Poor medication self-management skills have been associated with poor outcomes in this population as well. The presence and extent of an association between cognitive impairment and poor medication self-management skills in this population has not been clearly defined. Objective: We assessed the cognition of consecutive older adults hospitalized for heart failure, in relation to their medication self-management skills. Methods: We conducted a cross-sectional study of older adults (aged ≥65 years) who were hospitalized for heart failure and were being discharged home. Prior to discharge, we assessed cognition using the Mini-Cog. We also tested patients’ ability to read a pill bottle label, open a pill bottle safety cap, and allocate mock pills to a pill box. Pill allocation performance was assessed quantitatively (counts of errors of omission and commission) and qualitatively (patterns suggestive of knowledge-based mistakes, rule-based mistakes, or skill-based slips). Results: Of 55 participants, 22% were found to have cognitive impairment. Patients with cognitive impairment tended to be older as compared to those without cognitive impairment (mean age = 81 vs 76 years, p = NS). Patients with cognitive impairment had a higher prevalence of inability to read pill bottle label (prevalence ratio = 5.8, 95% confidence interval = 3.2–10.5, p = 0.001) and inability to open pill bottle safety cap (prevalence ratio = 3.3, 95% confidence interval = 1.3–8.4, p = 0.03). While most patients (65%) had pill-allocation errors regardless of cognition, those patients with cognitive impairment tended to have more errors of omission (mean number of errors = 48 vs 23, p = 0.006), as well as more knowledge-based mistakes (75% vs 40%, p = 0.03). Conclusion: There is an association between cognitive impairment and poor medication self-management skills. Medication taking failures due to poor medication self-management skills may be part of the pathway linking cognitive impairment to poor post-discharge outcomes among patients with heart failure transitioning from hospital to home.
Collapse
Affiliation(s)
- Erik H Howell
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Alpana Senapati
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Eileen Hsich
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eiran Z Gorodeski
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.,Center for Connected Care, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
50
|
Soones TN, Lin JL, Wolf MS, O'Conor R, Martynenko M, Wisnivesky JP, Federman AD. Pathways linking health literacy, health beliefs, and cognition to medication adherence in older adults with asthma. J Allergy Clin Immunol 2017; 139:804-809. [PMID: 27555454 PMCID: PMC5239763 DOI: 10.1016/j.jaci.2016.05.043] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 05/04/2016] [Accepted: 05/13/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited health literacy is associated with low adherence to asthma controller medications among older adults. OBJECTIVE We sought to describe the causal pathway linking health literacy to medication adherence by modeling asthma illness and medication beliefs as mediators. METHODS We recruited adults aged 60 years and older with asthma from hospital and community practices in New York, New York, and Chicago, Illinois. We measured health literacy and medication adherence using the Short Test of Functional Health Literacy in Adults and the Medication Adherence Rating Scale, respectively. We used validated instruments to assess asthma illness and medication beliefs. We assessed cognition using a cognitive battery. Using structural equation modeling, we modeled illness and medication beliefs as mediators of the relationship between health literacy and adherence while controlling for cognition. RESULTS Our study included 433 patients with a mean age of 67 ± 6.8 years. The sample had 84% women, 31% non-Hispanic blacks, and 39% Hispanics. The 36% of patients with limited health literacy were more likely to have misconceptions about asthma (P < .001) and asthma medications (P < .001). Health literacy had a direct effect (β = 0.089; P < .001) as well as an indirect effect on adherence mediated by medications concerns (β = 0.033; P = .002). Neither medication necessity (β = 0.044; P = .138) nor illness beliefs (β = 0.007; P = .143) demonstrated a mediational role between health literacy and adherence. CONCLUSIONS Interventions designed to improve asthma controller medication adherence in older adults may be enhanced by addressing concerns about medications in addition to using communication strategies appropriate for populations with limited health literacy and cognitive impairments.
Collapse
Affiliation(s)
- Tacara N Soones
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Jenny L Lin
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Melissa Martynenko
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY; Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai School of Medicine, New York, NY
| | - Alex D Federman
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY
| |
Collapse
|