Cognitive Function and Health Literacy Decline in a Cohort of Aging English Adults

Kobayashi, Lindsay C.; Wardle, Jane; Wolf, Michael S.; Wagner, Christian von

doi:10.1007/s11606-015-3206-9

Cited by 112 publications

(107 citation statements)

References 21 publications

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“…Previous work examining the implications of HL on hospital admissions among a mixed population of seniors and non-seniors has either not found this interaction or not examined for it (Baker et al, 1998; Mitchell et al, 2012; Murray, Tu, Wu, Morrow, Smith, & Brater, 2009). It is likely that the detrimental effects of low HL have special relevance for the elderly, as aging has been associated with increased risk of declining health literacy (Kobayashi et al, 2015). Such effects could be due in part to an increased relevance of HL among the elderly due to the higher burden of chronic disease requiring self-management efficacy to mitigate an increased vulnerability to functional decline (Parker, Ratzan, & Lurie, 2003).…”

Section: Discussionmentioning

confidence: 99%

“…While low HL is independently associated with adverse health outcomes, including hospitalization and mortality among senior patients (Baker et al, 2007; Baker, Wolf, Feinglass, & Thompson, 2008; Sudore et al, 2006), it is possible that low HL coupled with insufficient vision poses an even greater barrier to self-management (Press et al, 2011). However, much of the HL literature excludes patients with delirium (Kobayashi, Wardle, Wolf, & von Wagner, 2015) and poor vision (Matthiesen, Vela, & Press, 2015). …”

Section: Introductionmentioning

confidence: 99%

“…For instance, the HL literature has made frequent use of written HL assessment instruments and thereby excluded patients with poor vision (Kobayashi et al, 2015; Parker, Baker, Williams, & Nurss, 1995; Press et al, 2011; Press et al, 2012; Press et al, 2013; Press et al, in press). Therefore, the full extent of the risk of low HL among vulnerable seniors after discharge may not be fully realized.…”

Section: Introductionmentioning

confidence: 99%

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Postdischarge Falls and Readmissions: Associations with Insufficient Vision and Low Health Literacy among Hospitalized Seniors

Jaffee

Arora

Matthiesen

et al. 2016

Journal of Health Communication

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The role of patient-level risk factors such as insufficient vision has been under-studied. Because insufficient vision may interfere with health literacy assessments, the full impact of low health literacy among older patients with impaired vision is unknown. We sought to determine whether senior inpatients’ insufficient vision and low health literacy are associated with adverse outcomes post-discharge, specifically falls and readmissions. We conducted an observational study of adult medicine inpatients at an urban hospital. Visual acuity and health literacy were screened at bedside. Outcomes data were collected by telephone 30 days post-discharge. Among 1,900 participants, 1,244 (65%) were reached post-discharge; 44% had insufficient vision and 43% had low health literacy. Insufficient vision was associated with post-discharge falls among participants ≥65 years (adjusted odds ratio [AOR] 3.38, 95% confidence interval [CI] 1.42-8.05), but not among participants <65 years (AOR 1.44, 95% CI 0.89-2.32. Low health literacy was associated with readmissions among participants ≥65 years (AOR 3.15, 95% CI 1.77-5.61), but not among participants <65 years (AOR 0.78, 95% CI 0.56-1.09). The results suggest the need to implement screening for older inpatients’ vision and health literacy. Developing effective interventions to reduce these risks is critical given national priorities to reduce falls and readmissions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Postdischarge Falls and Readmissions: Associations with Insufficient Vision and Low Health Literacy among Hospitalized Seniors

Jaffee

Arora

Matthiesen

et al. 2016

Journal of Health Communication

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“…Given the high prevalence of poor health literacy among older adults, 1 identifying risk factors and potential opportunities for intervention is critical to improving health care in this vulnerable population.…”

Section: T O the Editorsmentioning

confidence: 99%

Health Literacy During Aging

2015

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T o the Editors:We applaud Kobayashi et al.'s recent publication entitled, BCognitive Function and Health Literacy Decline in a Cohort of Aging English Adults,^1 addressing the relationship between age and health literacy, inclusive of cognitive functioning. Given the high prevalence of poor health literacy among older adults, 1 identifying risk factors and potential opportunities for intervention is critical to improving health care in this vulnerable population.We note, however, that poor vision is an additional risk factor that may be critical to developing effective interventions for older patients. While Kobayashi et al. acknowledged Bsight difficulties^as a reason for non-completion of the health literacy assessment, excluding participants based on sight may have important implications for future study and patient impact. The patient's degree of vision loss was not documented and neither the vision assessment tool nor the parameters of vision loss were identified. Further, the results of participants with vision loss themselves differed across waves, from 1.5 % (132/8780) in wave 2 to 1.8 % (96/5330) in wave 5. Although the percentages within each group were fairly similar, it is not clear whether these represent the same or different participants, or if the criteria changed over the course of the study.Regardless of the tool used or changes across time, the percentage of poor vision identified in this population may significantly underestimate the actual proportion of older patients with poor vision. In a national survey of American adults aged 65 years and older, 21 % self-identified as having vision impairment.2 Further, at our institution, we have found that nearly half of hospitalized participants 65 years and older have poor vision (compared to about one-quarter among participants under 65). 3,4 This is salient, because both the health literacy assessment and the cognitive battery require participants to be able to see text. In prior research, we documented that patients 65 years and older have a dual risk for poor health literacy and poor vision when compared to their younger counterparts.4 Because older adults with poor vision have a higher risk of falls, delirium, and hastened physical and psychological decline, 5 it may be important to determine whether vision mitigates some of the demonstrated association between age, health literacy, and cognitive changes. Therefore, future work should avoid the exclusion of aging adults with poor vision and should attempt to further clarify the interaction of these risk factors in order to tailor appropriate interventions.

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“…3 In this issue, Kobayashi et al provide a glimpse at cognitive function and health literacy decline over time in a cohort of English subjects from the ages of 52 years or older as part of the English Longitudinal Study of Ageing. 4 This was done by using a reading comprehension assessment of a fictitious medicine label and assessing cognitive function decline between baseline (2004)(2005) and follow-up assessment 6 years later (2010-2011). A total of close to 5,000 patients participated in the original and follow-up studies.…”

mentioning

confidence: 99%

Capsule Commentary on Kobayashi et al., Cognitive Function and Health Literacy Decline in a Cohort of Aging English Adults

McNeal

2015

J GEN INTERN MED

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Cognitive Function and Health Literacy Decline in a Cohort of Aging English Adults

Cited by 112 publications

References 21 publications

Postdischarge Falls and Readmissions: Associations with Insufficient Vision and Low Health Literacy among Hospitalized Seniors

Postdischarge Falls and Readmissions: Associations with Insufficient Vision and Low Health Literacy among Hospitalized Seniors

Health Literacy During Aging

Capsule Commentary on Kobayashi et al., Cognitive Function and Health Literacy Decline in a Cohort of Aging English Adults

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