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Objectives Age is generally an inverse predictor of health literacy. However, the role of cognitive dysfunction among older adults in this relationship is not understood. Methods We conducted a cross-sectional survey of 446 adult patients in a large urban academic level one trauma center, assessing health literacy and cognitive dysfunction. Results Removing older patients (60 years of age and older) who screened positive for cognitive dysfunction attenuated the relationship between age and health literacy (r= -0.16, p=0.001 vs. r= -0.35, p<0.0001). Older patients screening positive for cognitive dysfunction had significantly lower health literacy than older patients screening negative and patients less than 60 years; health literacy scores did not generally differ significantly between the latter groups. Conclusions Much of the relationship between age and health literacy was driven by cognitive dysfunction among a subset of older adults. Practice implications Our findings suggest that older patients with cognitive dysfunction have the greatest need for health literacy interventions.

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