Do you work with or care for older adults? Do you see signs of low health literacy in the people you work with?…or perhaps you’re looking for health information for yourself – you’re welcome too. You’ll find lots of helpful health care related information on our site.
Low health literacy occurs when there is a gap between the knowledge and skills of the patient and the demands of today's healthcare system. There are tools you can use to help close that gap.
We invite caregivers, church groups, public libraries, senior centers, and any other person or organization working with older adults to take a look at the resources we've gathered. Your relationship with the people you work with can be great tool to closing the health literacy gap.
We're going to focus on these areas:
Studies show low health literacy is linked to poor health outcomes and is especially a concern for older adults.
You can find many definitions of health literacy, but this one from the National Library of Medicine is widely accepted:
Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.
Health literacy depends not only on the skills of the patient. Health literacy also depends on the ability of health care professionals to communicate effectively, in a manner which can be understood by the patient.
Low health literacy is clearly linked to poor health outcomes. According to a fact sheet from the United States Department of Health and Human Services, people who have limited health literacy skills:
In the United States, a 2006 report from the Department of Education, based on the 2003 National Assessment of Adult Literacy, estimates that only about 12% of the adult population are proficient in health literacy. The healthcare environment is becoming more complex at the same time the health care consumer is expected to assume more responsibility for his or her own care. Probably everybody will encounter some health literacy issues at some point. Still, we know that some segments of the population – including older adults – are more likely to experience poor health literacy.
Older adults scored the lowest of any age group on the health literacy portion of the 2003 National Assessment of Adult Literacy. Only 3% of older adults scored high enough to be considered proficient, while nearly 30% scored at the lowest level: "below basic."
Older adults are also far more likely to have multiple, chronic health conditions. The combination of their more complex healthcare needs and their lower health literacy skills is a dangerous combination.
Berkman ND, Sheridan SL, Donohue KE, et al. Agency for Healthcare Research and Quality. Health literacy interventions and outcomes: an updated systematic review. 2011 March Evidence Reports/Technology Assessments no.199.
Sudore RL, Schillenger D. Interventions to improve care for patients with limited health literacy. Journal of Clinical Outcomes Management. 2009 Jan 116(1):20-29.
Today's healthcare environment places many demands on patients. We are expected to take an active role in decisions about our treatment and goals even as rapid technological advances complicate nearly every decision. Health literate patients must be comfortable talking to doctors and other providers in order to get the information needed to make good decisions.
How can we help older adults gain the skills they need to effectively communicate with their healthcare providers?
The resources of the National Institute on Aging are a great place to start. Here you'll find:
The Agency for Healthcare Research and Quality (AHRQ) is another place to look:
Did you know that studies show that nearly 30 percent of hospital admissions among older adults are medication-related? Many older adults take multiple medications and have complicated dosing schedules.
Helping the older adults you serve to manage their medications may be one of the most valuable things you can do.
Here are some tools to get you started:
Marek KD, Antle L. Medication Management of the Community Dwelling Adult. In: Hughes RG, editor. Patient Safety and Quality: an Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality (US) 2008 Apr. Chapter 18.
Do you know how to find trustworthy sources of health information? Are you able to show older adults and their caregivers where to find the information they need?
Many of us turn to the Internet for health information, but an expert panel convened by the Centers for Disease Control reported that many older adults do not use the Internet. They may be unfamiliar with the computer, or they may have cognitive or vision issues which make using the computer difficult.
While you may be able to teach some willing older adults to find health information for themselves, it may be even more valuable for you to learn how to find the best information for them.
Many older adults have difficulty with printed materials you may find that video resources work well with this population.
If you are selecting health information materials to share with older adults, you will need to evaluate them not only for accuracy and reliability, but also for health literacy. Here's where to learn about evaluating health information resources for older adults:
We may need to think about another kind of literacy: health insurance literacy.
According one definition, developed by a group led by the Consumer's Union, and published in their report Measuring Health Insurance Literacy: a Call to Action, health insurance literacy is "the degree to which individuals have the knowledge, ability, and confidence to find and evaluate information about health plans, select the best plan for their own (or their family's) financial and health circumstances, and use the plan once enrolled."
Many people, including many older adults, need help finding their way through the Medicare and health insurance mazes. Here are some resources you can use to help find the right path.
Teach-back is an evidence-based method of ensuring that the listener understands your health-related message.
Many studies have shown that most spoken medical information is quickly forgotten, or incorrectly remembered. A 2003 article by Roy Kessels, Patients' Memory for Medical Information, describes how recall and understanding decrease with age. Stress and anxiety further limit a person's ability to remember spoken information. According to Kessels, only about 14 percent of spoken medical instructions are remembered correctly.
Teach-back is an evidence-based method of ensuring that the listener understands your health-related message. By asking your listener to explain the information back to you, you can assess and confirm their understanding of the material you've presented.
Is there a way to measure how well we are communicating? Can we track how well we are doing?
The CAHPS Item Set for Addressing Health Literacy may help start with the appendix beginning on page 4 of their website. The survey asks 31 questions. A shorter version, with only 5 questions, may tell you what you need to know. Ask your patients to rate how well you communicate health information to them.
Are you interested in learning more about health literacy? Perhaps you want to teach other health professionals. Or maybe you would like to earn some continuing education credits. Here's how:
Thanks to TFEC’s Task force on Aging & Health Disparities for the support of this page. Of special note, thanks to the work of Bob Haigh and his commitment to health in our communities.
