Health Literacy and the Older Adult
Clinical
Advisor: 2.27.2019 by Gwenn Scott RN, DNP, CNS, FNP-BC
Mr C, a 72-year-old patient with
type 2 diabetes, is brought to the emergency department comatose with a blood
sugar of 29 mg/dL. When seen in his primary care provider’s office the
previous day, his blood sugar was 456 mg/dL; he was prescribed fast-acting
insulin with meals in addition to an increase in his insulin glargine.
Every
day, low health literacy results in patients’ misunderstanding the instructions
of their clinicians, sometimes with very serious consequences. Mr C did not
understand his clinician’s verbal and written instructions and took too much
fast-acting insulin at breakfast.
An
estimated 90 million people in the United States have low basic literacy
skills, with the average adult reading at an eighth-grade level. Almost
20% of American adults cannot read and almost 30% do not read well, for a
combined level of approximately 50% who have some difficulty reading at even a
fifth-grade level. This group of Americans with limited reading skills
comprises several demographic groups, including older adults, Latinos, African
Americans, American Indians, and Alaskan natives.
Health
Literacy
This
low basic literacy is combined with widespread illiteracy associated with
health information. Health literacy is multifaceted and includes printed
literature, oral communication, and numeracy. Printed literature requires
reading and writing ability, while oral literacy requires the ability to listen
and speak.
Many older adults have vision and/or hearing loss that
represent additional obstacles to health literacy. Numeracy — the ability to
understand and use numbers — is especially important with respect to medication
dosages.
Even
people with high basic literacy skills can have low health literacy, and
medical jargon can seem like a foreign language to many people. The most
widely used definition for health literacy is “the ability to obtain, process,
and understand basic health information and services needed to make
appropriate healthcare decisions
and follow instructions for treatment.”
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Older
Adult Learning Theory
Before
we can address best practices to overcome low health literacy, we need to
understand how older adults learn and factors that could impede older adult
learning. Geragogy involves the principles of older adult learning theory.
Factors affecting learning can be physical functions such as vision, hearing,
and mobility. Increasing age can be associated with a decrease
in vision and hearing, as well as slower psychomotor abilities.
Adjustments in teaching will need to be made when educating these
patients. Cognitive factors need to be considered.
Older adults may have
decreased short-term memory and a tendency to be distracted. Repetition
is a key element in teaching the older adult.
Elliot
identified the following principles of older adult learning:
➤ “Approach
the older adult in a way that communicates respect, acceptance, and support.
Create a learning environment in which the patient can feel comfortable
when expressing what is and is not understood.”
➤ “Schedule
teaching session in mid-morning when energy levels are usually highest for the
older adult. Conduct several brief sessions over different days rather than one
long session, which may cause fatigue.”
➤ “Provide
more time for the older adult to process new information.”
➤ “Link
new knowledge to past experiences. Reminiscing helps the older adult
reconnect with lived experiences.”
Health
Quick
Guide to Health Literacy and Older Adults, US Dept of Health & Human
Services
2019:
Health Literacy in the 50 States, Health
IQ (an Insurance Co.)
2018:
How Health Literacy Got Started, Helen
Osborne
2017:
Hidden Cost of Healthcare System Complexity, Accenture
2015:
Health Literacy & Patient Engagement, 12th Annual Report, US
HHS Sep 2015
2011:
Health Literacy Interventions Outcomes: Updated Systematic Rvw, AHRQ
2010:
Health Literacy, NNLM
2010:
Health Literacy: Accurate Accessible Actionable Health Info. for All, CDC
2009:
Reaching America’s Health Potential Among Adults, RWJ Foundation
2009:
Low Health Literacy, NAAL
2003
2004:
Literacy and Health in America, ETS
2004:
Health Literacy: A Prescription to End Confusion, National
Academy of Sciences
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