Association between community-level health literacy and frailty in community-dwelling older adults

Uemura, Kazunori; Kamitani, Tsukasa; Watanabe, Atsuya; Okamoto, Hiroshi; Yamada, Minoru

doi:10.1007/s40520-023-02405-y

Cited by 5 publications

(3 citation statements)

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“…These results are consistent with previous studies reporting that frailty has a significant negative effect on health literacy ( 43 , 58 ). The higher the frailty of the participant(s), the more their physiological capacity was reduced, which was associated with increased susceptibility to stressors, and the less likely they were able to obtain health-related information and, consequently, the lower their health literacy.…”

Section: Discussionsupporting

confidence: 93%

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Frailty and medication adherence among older adult patients with hypertension: a moderated mediation model

Wang,

Wan,

Zhu

et al. 2023

Front. Public Health

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ObjectiveMedication adherence has a critical impact on the well-being of older adult patients with hypertension. As such, the current study aimed to investigate the mediating role of health literacy between frailty and medication adherence and the moderating role of educational level.MethodsThis cross-sectional study included patients admitted to the geriatric unit of a hospital. Participants were interviewed using the four-item Morisky Medication Adherence Scale, the Frailty Phenotype Scale, and the Health Literacy Management Scale. Spearman’s correlation coefficients were used to assess the association between variables. Mediation and moderated mediation analyses were performed using Process version 4.1 via Model 4 and 14, respectively.ResultsData from 388 participants were analyzed. The median (IQR [P25–P75]) score for medication adherence was 4.00 (2.00–4.00). Results revealed that after controlling for age, sex, hypertension complication(s) and body mass index, frailty significantly contributed to medication adherence (βtotal −0.236 [95% confidence interval (CI) −0.333 to −0.140]). Medication adherence was influenced by frailty (βdirect −0.192 [95% CI −0.284 to −0.099]) both directly and indirectly through health literacy (βindirect −0.044 [95% CI −0.077 to −0.014]). Educational level moderated the pathway mediated by health literacy; more specifically, the conditional indirect effect between frailty and medication adherence was significant among older adult hypertensive patients with low, intermediate, and high educational levels (effect −0.052 [95% CI −0.092 to −0.106]; effect −0.041 [95% CI −0.071 to −0.012]; effect −0.026 [95% CI −0.051 to −0.006]). The relationship between frailty and medication adherence in older adult patients with hypertension was found to have mediating and moderating effects.ConclusionA moderated mediation model was proposed to investigate the effect of frailty on medication adherence. It was effective in strengthening medication adherence by improving health literacy and reducing frailty. More attention needs to be devoted to older adult patients with hypertension and low educational levels.

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Section: Discussionsupporting

confidence: 93%

“…In addition, some studies have demonstrated an association between frailty and the absence of health literacy ( 56 , 57 ). The association between adequate health literacy and a lower frequency of frailty was also supported by a recent study conducted in 2023 among older community-dwelling adults ( 58 ).…”

Section: Introductionmentioning

confidence: 59%

Frailty and medication adherence among older adult patients with hypertension: a moderated mediation model

Wang,

Wan,

Zhu

et al. 2023

Front. Public Health

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“…In these studies, a multilevel analytical approach that can differentiate the influences of community- and individual-level factors was commonly utilized to understand the contextual effects. We also reported that older adults living in communities with higher health literacy are less likely to be frail, in addition to the benefits of individual-level health literacy, in a cross-sectional study using multilevel analyses 42) .…”

Section: Application Of An Ecological Model For Frailty Preventionmentioning

confidence: 78%

Frailty and Environmental Attributes in Older Adults: Insight from an Ecological Model

UEMURA,

KAMITANI,

YAMADA

2023

Phys Ther Res

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Many studies on frailty have primarily focused on individual-level risk factors such as demographics and lifestyle. While guidelines for frailty management recommend modifications to an individual’s lifestyle, their lifestyle behaviors are significantly influenced by their surroundings. Recently, the association between frailty and environmental attributes has drawn attention as a result of the increase in evidence that multiple factors affect health conditions and behaviors associated with frailty. These findings can be organized based on an ecological model involving five nested levels that influence an individual’s behaviors, namely, an intrapersonal/individual core (age, education, and attitude), an interpersonal level (persons and groups), an organizational/institutional level (organization and workplace), a community level (natural, built, and social environments), and a system/public policy level (public policies from local to national). This study reviewed possible factors associated with frailty from the onset and its progression at each level of the ecological model and their implications regarding frailty prevention. Additionally, we introduce a policy-level approach for frailty prevention in Japan—which encourages residents to engage in the local society by participating in community places or groups that are referred to as ”Kayoi-no-ba”—and aggregate its status from a government report. This perspective on community building is consistent with the concept of an ecological model. However, few studies have verified the effects of policy- or system-level approaches on disability and frailty prevention. Further studies from an ecological perspective are needed to fulfill multilevel interventions for frailty prevention.

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Introduction to health and medication literacy

Awaisu,

Zoukh

2025

Health Literacy in Medicines Use and Pharmacy

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Association between community-level health literacy and frailty in community-dwelling older adults

Cited by 5 publications

References 50 publications

Frailty and medication adherence among older adult patients with hypertension: a moderated mediation model

Frailty and medication adherence among older adult patients with hypertension: a moderated mediation model

Frailty and Environmental Attributes in Older Adults: Insight from an Ecological Model

Introduction to health and medication literacy

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