Low health literacy and multiple medications in community-dwelling older adults: a population-based cohort study

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

OBJECTIVES

To identify factors associated with poor health literacy in older adults.

METHODS

A systematic literature review was conducted, employing the descriptors "Aged" and "Health Literacy".

PROSPERO - CRD

42022350140.

RESULTS

Out of 23,500 articles screened, 176 were selected. Several factors associated with poor health literacy in older adults were identified, such as sociodemographic (e.g., advanced age, low educational level, non-white population, and others), social (e.g., poor family/social support, loneliness, social isolation, few social activities, and others), economic (e.g., lower income and/or lower socioeconomic status) and health aspects (e.g., poor health, chronic conditions, mental health challenges, hospitalizations, frailty, physical inactivity, cognitive impairment, and others).

CONCLUSIONS

The factors associated with poor health literacy in older adults identified in this review could contribute to future research, support interventions to improve health literacy, and assist professionals in planning educational activities and public policies.

Deprescribing in Real Time: Hospitalized Septuagenarian With Polypharmacy

Polypharmacy is a common and potentially preventable contributor to recurring emergency room visits, hospitalization, morbidity, and mortality. Its consequences are magnified in older adults due to the age-related decrease in functional and physiologic reserves, increased blood-brain barrier permeability, and altered drug metabolism, among others. In this article, we describe a case of polypharmacy in a septuagenarian to highlight the deprescribing approach implemented by the inpatient care team and to offer patient-centered insights to clinicians (primary care providers and hospitalists) when making deprescribing decisions. The overarching aim of this article is to build on existing literature regarding polypharmacy, prescribing cascades, and deprescribing in the context of what matters most and aligns with patient health priorities. This article highlights the importance of good geriatric medication reconciliation stewardship to avoid harm.

Health literacy status among community in the protected area: A protocol for systematic review and meta-analysis

BACKGROUND

Adequate health literacy is necessary for individuals as it enables them to readily acquire information, process it, and apply it to health-related decisions. Various factors including geographical area will determine the disparity in health literacy status. Communities living in protected areas have limited health literacy and health status owing to a lack of access to infrastructure and medical facilities. Existing studies have discussed health literacy among various populations disproportionately affected by certain diseases. However, research remains underdeveloped, and the causal factors are largely untested. This research aims to better understand how population living conditions especially those who are living in protected areas are affected and exposed to limited health literacy.

METHOD

This study will comprehensively review full-text papers published between 2013 and 2023. We will search 3 databases, PubMed, SCOPUS, and Web of Science, using the keyword search strategy to find articles related to the issue. Preferred Reporting Items for Systematic Reviews and Meta-Analyses will be used to guide the selection of relevant studies. The results will then be assessed using the standard Cochrane Quality assessment method. The outcome is addressed in light of a narrative synthesis that utilizes a theme category and focuses on each component's main conclusions.

RESULT

This protocol describes the planned scope and methodology for the systematic review and meta-analysis that will provide current evidence on; The status of health literacy among the community in protected areas and; The effect of Protected Areas on health literacy according to their types and characteristics.

CONCLUSION

Meta-analysis of low-to-high health literacy status will benefit the development of policy recommendations for protected areas.

Exploring Older Adult Health Literacy in the Day-to-Day Management of Polypharmacy and Making Decisions About Deprescribing: A Mixed Methods Study

BACKGROUND

Polypharmacy use in older adults is increasing and sometimes leads to poor health outcomes. The influence of health literacy in managing polypharmacy and making decisions about stopping medication has received limited attention.

OBJECTIVE

A mixed methods design was used to measure and investigate the influence of health literacy in the management of polypharmacy and decisions about deprescribing. Phase 1 involved two cross-sectional surveys, one with older adults using five or more medications and the other with general practitioners (GPs).

METHODS

Older adult health literacy was measured using the All Aspects of Health Literacy Scale. Phase 2 employed individual interviews with both older adults and GPs and further explored the reported use of health literacy in practice. SPSS version 24 was used to conduct descriptive statistical analysis of the Phase 1 survey responses and Phase 2 interviews were analyzed using thematic analysis with the assistance of NVivo 12.

KEY RESULTS

Phase 1 survey responses were received from 85 GPs and 137 older adults. Phase 2 interviews were conducted with 16 GPs and 25 older adults. Phase 1 results indicated that self-reported older adult health literacy was high, and that GPs believed older patients could engage in decisions about deprescribing. Phase 2 findings showed that older adults developed and employed complex health literacy practices to manage medications between consultations; however, few reported using their health literacy skills in consultations with their GPs. GPs noted that older adult involvement in decision-making varied and generally thought that older adults had low health literacy.

CONCLUSION

Older adults reported using health literacy practices in the management of their sometimes-complex medication regimens. However, the role of health literacy in deprescribing decision-making was limited. The mixed methods approach allowed greater insight into older adult and GP practices that influence the acquisition and use of health literacy. [HLRP: Health Literacy Research and Practice. 2023;7(1):e14-e25.] Plain Language Summary: This report explores health literacy in the use of multiple medications and decisions to stop using medication/s in older age. Older adults reported good heath literacy and practiced many health literacy skills in the management of their medications. However, they did not always report the use of their health literacy skills when discussing their medications with their family doctor.