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Senior Health & Medicine
Low Literacy Equals Poor Health for Senior Citizens
Study finds 25% of
elderly between 70 and 79 had limited literacy
May 26, 2006 - People aged 70 years and older with
limited literacy skills are one and one half to two times as likely to
have poor health and poor health care access as people with adequate or
higher reading ability, according to a study led by researchers at the
San Francisco VA Medical Center and the University of California, San
Francisco.
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Elders with limited literacy, which the researchers
define as a reading level lower than ninth grade, were one and a half
times more likely than other study participants to report poor overall
health and diabetes, and twice as likely to report depression. The study
authors note that self-reported health has been found in other studies
to correlate strongly with actual health.
The study of 2,512 community-dwelling elders
between the ages of 70 and 79 revealed that one in four had limited
literacy. In practical terms, these elders "may have trouble reading
basic health information or pill bottle instructions," according to lead
author Rebecca Sudore, MD, a staff physician at SFVAMC.
The study appears in the May 2006 issue of the
Journal of the American Geriatric Society.
The researchers also found that people with a
sixth-grade or lower reading level were twice as likely as the
ninth-grade and above group to have poor access to health care, as
measured by lacking a regular doctor or place of care, a flu shot within
the previous year, or insurance to cover medication. Subjects with a
seventh- to eighth-grade reading level also had less health care access
compared to the ninth-grade group, but after accounting for other
factors the differences were not statistically significant, according to
Sudore.
The study authors emphasize that all results were
adjusted for, and therefore independent of, patients' socioeconomic
background and level of education.
"As a geriatrician, the results of this study break
my heart," says Sudore, who is also an assistant adjunct professor of
medicine at UCSF. "Elders already have the highest medication and
disease burden. Adding limited literacy to the list of problems makes
these elders particularly vulnerable to poor outcomes, as we found in
our study."
The study analyzed data from in-person interviews
of participants in the Health, Aging, and Body Composition Study
conducted by the National Institute on Aging. Study subjects lived
independently in the community in Memphis, Tenn., or Pittsburgh, Penn.
The study excluded participants with dementia or poor physical
functioning.
"Elders with limited literacy have a hard time
reading their pill bottles, managing their diseases, filling out needed
forms for their care, and being able to navigate through the health care
system," notes Sudore. "Unfortunately, in this study, we found that the
very group of elders who would benefit from having more access to health
care actually had worse access. Since the elders in our study were
fairly well-functioning, problems accessing care and managing disease
are likely to be even worse for frailer elders."
The design of the study precluded an exploration of
the reasons for the links between literacy, health, and health access,
says Sudore, but she offers some possible explanations: "Patients with
limited literacy may not understand instructions given to them by their
clinicians, or grasp the importance of follow-up care. In addition,
there may be elements of fear or intimidation or lack of trust in the
health care establishment." Plus, she says, limited literacy may prevent
elders from being able to properly fill out forms needed to obtain
medical resources such as insurance and medications.
Sudore points out that among the study
participants, literacy did not necessarily correlate with level of
education, "which suggests that simply asking if someone graduated from
high school will not tell you whether the person can understand his or
her physician or read a prescription bottle. For our patients' sake, we
need to be careful not to make assumptions about literacy skills. It is
our responsibility, as clinicians, to talk to and to educate all of our
patients in a way that they can understand."
Sudore says further research is needed to identify
interventions that would prevent poor health outcomes in these
"vulnerable elders." She points to multidisciplinary education programs
that have been shown to be successful in geriatric and low-literacy
populations. "Combining these two efforts may be what is needed," she
speculates.
In the long run, predicts Sudore, successful
interventions would save money for taxpayers: "People with limited
literacy skills have worse health outcomes, poor access to health care
as our study showed and are more likely to get their care in the
emergency room and to be hospitalized, which has been shown to incur
higher health care costs."
More about study:
Co-authors of the study were Kala M. Mehta, DSc, of
SFVAMC; Eleanor M. Simonsick, PhD, and Tamara B. Harris, MD, of the
National Institute on Aging; Anne B. Newman, MD, MPH, of the University
of Pittsburgh; Suzanne Satterfield, MD, of the University of Tennessee;
Ronica M. Rooks, PhD, of the University of Pittsburgh; Susan M. Rubin,
MPH, and Hilsa N. Ayonayon, PhD, of UCSF; and Kristine Yaffe, MD, of
SFVAMC and UCSF.
The research was funded by grants from the National
Institute on Aging and the National Institutes of Health. SFVAMC has the
largest medical research program in the national VA system, with over
200 research scientists, all of whom are faculty members at UCSF.
UCSF is a leading university that consistently
defines health care worldwide by conducting advanced biomedical
research, educating graduate students in the life sciences, and
providing complex patient care.
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