Self‐Management Behaviors in Older Adults with Asthma: Associations with Health Literacy

Abstract

Background/Objectives: Older adults asthmatics experience high rates of morbidity and mortality yet little is known about their self-management behaviors. We examined self-management behaviors, including medication adherence and inhaler technique, among older adults and their association with health literacy. Design: Observational cohort study. Setting: Primary care and pulmonary specialty practices in two tertiary academic medical centers and three Federally Qualified Health Centers in New York City, NY and Chicago, IL. Participants: Adults with moderate or severe persistent asthma, ages 60 years and older (n=433). Measurements: Outcomes were adherence to asthma controller medications, metered dose inhaler (MDI) and dry powder inhaler (DPI) techniques, having a usual asthma physician, and avoidance of four common triggers. Health literacy was assessed with the Short Test of Functional Health Literacy in Adults. Results: The mean age was 67 years and 36% had marginal or low health literacy. Adherence was low (38%) overall and worse among individuals with low health literacy (22% vs. 47%, p<0.0001) and after adjusting for demographic factors and health status (odds ratio [OR] 0.48, 95% confidence [CI] 0.31-0.73). Similarly, inhaler technique was poor: only 38% and 54% had good MDI and DPI technique, respectively. Technique was worse among those with low health literacy (MDI technique: OR 0.57, 95% CI 0.38-0.85; DPI technique: OR 0.42, 95% CI 0.25 to 0.71). Asthma self-monitoring and avoidance of triggers occurred infrequently but were less consistently associated with low health literacy. Conclusion: Adherence to medications and inhaler technique are poor among older asthmatics, and worse among those with low health literacy. Clinicians should routinely assess controller medication adherence and inhaler technique, and use low-literacy communication strategies to support self-management in older asthmatics.

Functional health literacy and adherence to the medication in older adults: integrative review

“…To assess adherence to medication, one of the instruments used were the Medication Adherence Reporting Scale for Asthma (MARS-A) (26) . This tool is a measure of 10 items, validated, which was adapted to verify self-report of adherence to inhaled corticosteroids, which goes according to the objectives of the studies surveyed, related to asthma (22)(23) . It can be a tool used by nurses to aid in research or clinical practice in asthma.…”

“…The articles also bring the importance of adapting such care, according to the specificities of the older adult and individual needs of each patient, taking into account his family, his preferences and his culture (19)(20)(21) . It is also highlighted the importance of multi/interdisciplinary teamwork and the importance of the link and a good relationship between the professional and the patient (20,22) . Certain strategies are even addressed, like strategies for monitoring and assessment of both the adherence to the medication and the FHL, the previous knowledge of the patient, through the application of methods, instruments or questionnaires, in clinical practice, and regular monitoring, always encouraging self-care (17,(19)(20)22) .…”

“…It is also highlighted the importance of multi/interdisciplinary teamwork and the importance of the link and a good relationship between the professional and the patient (20,22) . Certain strategies are even addressed, like strategies for monitoring and assessment of both the adherence to the medication and the FHL, the previous knowledge of the patient, through the application of methods, instruments or questionnaires, in clinical practice, and regular monitoring, always encouraging self-care (17,(19)(20)22) . Two articles highlight the importance of further research to identify more accurate methods of evaluation, the exploration of the factors that lead to non-adherence and the inadequate FHL, as well as the problems with drug therapy (17)(18) .…”

“…The fifth article states that the FHL is directly related to inaccurate beliefs about medicines for asthma, influencing the non-adherence to medication (21) . Finally, the sixth (22) and seventh articles found that individuals with inadequate FHL have low adherence to medication and worst self-care for asthma (23) . As for the strategies and interventions related to adherence and to the FHL, the following results were obtained: first, it was brought the importance of education, communication and patient guidance, in addition to the use of methods more suitable in interventions, such as using proper language, simplifying reading materials and adapting care as needed and resources of each individual (19)(20)(21)(22)(23) .…”

“…Finally, the sixth (22) and seventh articles found that individuals with inadequate FHL have low adherence to medication and worst self-care for asthma (23) . As for the strategies and interventions related to adherence and to the FHL, the following results were obtained: first, it was brought the importance of education, communication and patient guidance, in addition to the use of methods more suitable in interventions, such as using proper language, simplifying reading materials and adapting care as needed and resources of each individual (19)(20)(21)(22)(23) . The articles also bring the importance of adapting such care, according to the specificities of the older adult and individual needs of each patient, taking into account his family, his preferences and his culture (19)(20)(21) .…”