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General Principles in Older Adults

Health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services to make appropriate health decisions.” The construct of health literacy is complex. It involves reading and writing, listening and verbal communication skills, and computational or numeracy skills required for such tasks as pill counting or insulin dosing. Limited health literacy (LHL) is thought to occur at or below an eighth grade reading level. Language barriers also contribute to LHL, and the number of foreign-born, older adults in the United States who have limited English proficiency is growing. Health literacy is also a function of the health care environment, which places a heavy burden on patients to manage their own complex disease processes and health care benefits.

It is estimated that close to half of U.S. adults have LHL, and up to 90% report difficulty with routine health information. The prevalence of LHL increases among older age groups, with the prevalence reported as high as 60% among older populations. Although the average adult in the United States reads at an eighth-grade level, adults age 65 years or older read at a fifth-grade level. Older adults with LHL have been shown to have significant difficulty weighing the risks and benefits of complex treatment options and to have difficulty reading medical forms. Yet, most health care materials are written at or beyond a college reading level. LHL also results in worse clinical outcomes for older adults including poor functional status, disparities in health care access and the receipt of preventative services, worse chronic disease management, increased hospitalization, and increased mortality. By universally adopting clear health communication techniques outlined in this chapter, clinicians can help ensure informed medical decision making and patient safety for all patients, and especially for older adults with LHL.

Unique Health Literacy Considerations in Older Adults

For all age groups, LHL has been found to be more common among persons of lower socioeconomic status, limited education, and limited English proficiency. However, many unique, patient-related factors contribute to LHL in older populations (Figure 69–1), including a high prevalence of impairments in hearing, vision, and cognition, as well as a high burden of chronic disease and polypharmacy. A caregiver’s LHL may also affect a patient’s medical care and safety.

Figure 69–1.

Unique health literacy considerations in older adults.

Hearing and Vision Impairment

Hearing impairment, a significant contributor to LHL, is common among older adults, with estimates as high as 63% among adults older than age 70 years. Clinicians and patients often miss a diagnosis of hearing loss. Up-to-date audiology evaluations and access to hearing aids is a first step. For patients whose hearing is undercorrected with hearing aids, small portable sound amplifiers (eg, ...

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