How to Improve Health Literacy in Older People

Many studies that appear in the professional literature show the need for increased understanding on the part of older people in dealing with their personal health issues. The February 10, 1999 issue of Journal of American Medical Association (JAMA) cited a survey done of the elderly, using the Short Test of Functional Literacy in Adults, which attempted to measure health literacy. The results again pointed out the need for the medical profession to take extra steps to ensure that their older patients understand information presented to them during office visits.

The study found that more than one-third of the older persons surveyed evidenced inadequate or marginal health literacy, with nearly 25% of those who spoke English as their native language showing inadequate health literacy. Adjusting the data for level of education and cognitive impairment still indicated that age was strongly correlated to inadequate health literacy: nearly 16 percent of those individuals between 65 to 69 exhibited inadequate literacy, compared with 58% of those 85 years and older.

Further analysis of the data presented indicated that 43.6% of the elderly in the study were taking more than three medications per day and that 66.5% had at least one of five chronic conditions (COPD, coronary heart disease, heart failure, hypertension or diabetes).

Medical professionals must make stronger efforts to give extended information to the elderly. This means taking extra time with older people, repeating prescription directions, writing information in a clear understandable fashion, checking on adherence to medical regimens, etc. It also means that older people need to prepare for their visit to medical professionals by writing down any questions they may have about their condition or medication or test results. We would also suggest that a family member or friend accompany an older person on their medical visit. With the prevalence of chronic diseases and polypharmacy in the elderly, the need is even greater for this type of exchange of information.

One of our medical friends, a Geriatric Physician, told us that he insists that every individual over 60 bring in all the bottles of medications being taken including over-the counter medications, vitamins, herbal and other supplements. He also asks if they have "borrowed" any medications from friends who may have told them how good the medication was in the treatment of their illness. He does this to insure himself of possible drug-drug interactions, contraindications etc. It seems like a good thing to do in a patient -doctor relationship.

In any patient-physician relationship negotiations go on in terms of what needs to be discussed, what should be discussed, what ought to be kept secret and what might be discussed. There can be no doubt that communication affects patient outcome. It would appear that the discrepancies between the knowledge, the expectations and goals of patient and physician could interfere with the outcome of treatment. It would seem essential that both parties to this relationship exchange communications that maximize the chances of the treatment succeeding. Managed care must not remove this obligation on both parties part, especially with the older person.

We like to think that readers of this web site will expose themselves to a range of information that will enhance the doctor-patient relationship and thus increase their chances of a healthy outcome. Medical information on this site is included for that purpose only. It is not intended to replace consultation with a qualified medical practitioner. If you have any concerns about your health, you should see your medical doctor.

We recommend the following resources for related information on this topic:

Kutner S., et al. Information needs in terminal illness. Social Science & Medicine. 1999; 37:1341-1352.

Silverstein MD et al. Amyotrophic lateral sclerosis and life sustaining therapy: patientsí desire for information, participation in decision making and life-sustaining therapy. Mayo Clinic Proceedings. 1991; 66:906-913.

Hack TF, et al. Relationship between preferences for decisional control and illness information among women with breast cancer. Social Science & Medicine. 1994; 32:279-289.


Harold Rubin, MS, ABD, CRC

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