Increasing Health Literacy Among Older Adults: Why It Matters Akron Beacon Journal

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Health Communication

Increasing Health Literacy Among Older Adults: Why It Matters

Akron Beacon Journal: 7.14.2020 by Diana Spore, MHRB

Prior to the pandemic, we were beginning to prioritize the need for shared decision-making between older care-recipients and care-providers, to empower patients to make well-informed choices. As we attempt to keep everyone informed about the coronavirus public health crisis, it has become even more important to assess and increase health literacy among older adults. Seniors are more vulnerable to contract the coronavirus and to become ill after being exposed. It is crucial for seniors to understand symptoms and safety precautions. Also, they need to be aware of when it is necessary to go to health care providers or to the emergency room (including for reasons other than the coronavirus).

Definition of health literacy

Health literacy is defined by the CDC as the “degree to which an individual has the capacity to obtain, communicate, process and understand basic health information and services to make appropriate health decisions.” Health literacy levels are associated with a variety of factors, including education, culture, age and socioeconomic status.

Lower levels of health literacy are linked with advanced age. This is related to some changes associated with aging as well as with impairment in sensory status (hearing, vision impairment), with physical health status, and with cognitive processing limitations.

Health literacy is a complicated concept. Familiarity with the following play in to the level of health literacy:

➧ basic mathematical skills,

➧ knowledge about health insurance options,

➧ reading comprehension,

➧ communication skills,

➧ understanding about financial matters,

➧ skill in interpreting bar graphs,

➧ adeptness with computer use.

Those who have lower health literacy levels tend to come into the health care system when they are more ill. They are more likely to use services that are meant to treat problems or deal with medical “crises” in an emergency room setting. In contrast, those who have higher health literacy levels use preventive care and are less likely to use the emergency room to secure services when problems arise.

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There is a complex relationship between levels of health literacy and compliance with physician orders at any time, and during this pandemic. Research findings indicate that patients with limited health literacy are more likely to be noncompliant. However, there is a difference between patients being noncompliant due to limited health literacy versus being noncompliant when they have high health literacy and knowledge about critical issues. Older patients are more likely to take history and knowledge about their specific illnesses into account – assessing risks versus benefits for some tests, medications, types of health service used. During this pandemic, patients may not schedule and follow-through on tests and procedures due to fear of being exposed to the coronavirus and contracting it, even with safety precautions in place. It makes sense that seniors – regardless of health literacy levels -- might feel it would be best to deal with these matters after the dust settles.

Health literacy issues during this pandemic

It is essential to access credible websites to keep on top of the coronavirus situation, to be able to see graphics or images that show what the safety precautions are.

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CDC

Graphics and images work in “reaching” patients, in simple yet effective and understandable ways. However, we need to consider what other types of resources or tools need to be designed for specific audiences, especially seniors. Also, we need to consider what verbal communication strategies will be most effective as telehealth is prioritized.  READ MORE ➤➤

Automatic Readability Checker

Based on 7 readability formulas:

Grade Level: 13

Reading Level: difficult to read.

Reader's Age: 18-19 yrs. old

(college level entry)

Literacy – Spanning North America :: Invermere BC :: Luxemburg WI :: Farmington ME :: Wilmington NC

Literacy: Spanning North America

@cbaliteracy

Nelson Woman Celebrated For Achievement In Literacy

Neslon Star: 6.18.2019 by Tyler Harper

Paulina Mason used to struggle to comprehend printed words and sentences.

Ten years later, the Nelson native is an aspiring author, a literacy advocate and the recipient of a local award that honours dedication to a task most take for granted — reading.

Mason, 28, was feted Friday by the Columbia Basin Alliance for Literacy (CBAL) with its ninth annual award handed out to an adult literacy student, while Kootenay Co-op was also recognized for its commitment to learning in the workplace.

A decade ago Mason had just finished high school when her mother Barb asked CBAL to help her daughter.

“I learn by visuals and sounds, symbols and pictures,” said Mason. “The old school way, sound this out, figure that out, I can’t do that because my brain doesn’t click to that.”

She describes her first tutor, a woman named Ellen, as a grandmother to Mason. “It’s nice to have that support other than school. Just knowing that someone wants to help you and see your progress in a good way, it was awesome.”

Community literacy co-ordinator Joan Exley said Mason has progressed from pupil to volunteer mentor at CBAL.  READ MORE >>

Literacy Partners 

Kewaunee Co

Retirees Aid Adult Literacy Efforts and See Lives Transformed

Door County Daily News: 6.18.2019 by Ben Caxton

Marge Weichelt wanted to stay connected to Kewaunee when she retired from teaching. The Kewaunee County Literacy Partnership provided that opportunity for her and, later on, for her husband, Joel. Both now serve as adult literacy tutors. Marge meets weekly with adult workers at East Shore Industries. Joel stepped up to tutor a young man from Mexico with limited English skills after his previous tutor had to quit for health reasons.  LISTEN 02:12

LVFSC

Literacy Volunteers Looks To Expand

Daily Bulldog: 6.19.2019 by Amber Kapiloff

A small non-profit is looking toward big changes ahead thanks to a recently awarded grant that is addressing the grand scheme of things, according to Literacy Volunteers of Franklin and Somerset County Executive Director Barbara Averill.

"We've come such a long way in the last year. It's gratifying to receive such a vote of confidence," Averill said.

The $36,000 Betterment Fund grant will be spread out over a three-year period- a characteristic that Averill said they were specifically looking for. The two-person staff at LV has secured $50,000 worth of grants in the last year alone, but only the Betterment Fund will be in place for an extended amount of time.

In addition to having a longer life, which offers a sense of security Averill said, the grant is also not program specific. Averill and her assistant, Sara Beech, can use the funds wherever they are needed. In Averill's opinion, that was a no-brainer.

"We want to look at opportunities in the northern region [of the county] that build collaboration. We know the need is there, but we also know that you can't just go lolling into a community and say 'here we are, come on in,'" she said.

Thanks to the grant, Averill, Beech and the 72 volunteers that make up LV have begun the process of searching for two new anchor sites for programming.  READ MORE >>

@cfliteracy

Cape Fear Literacy Council Changing Lives By Teaching Adults How To Read

WWAYTV 3: 6.21.2019 by Jeff Rivenbark

While most people have literacy skills, a surprisingly high number of people across the Cape Fear lack these skills and are either unable to read or have extreme difficulty doing so.

Since its formation, the Cape Fear Literacy Council (CFLC) has recruited, trained and certified approximately 2,000 volunteer tutors, and has donated thousands of hours helping adult learners across the region.

Alan Perry, owner of Perry’s Emporium in Wilmington, served as a CFLC board member for 22 years.

“I’ve always had a passion for literacy because my father never got past the second grade and he didn’t ever really learn how to read,” Perry said. “This is something I’ve always been passionate about.”

Perry says an estimated 50,000 people living in Pender, New Hanover and Brunswick counties are unable to read.  WATCH 03:11

Health Literacy and the Older Adult via Clinical Advisor

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.”

READ MORE >>

Literacy Reports & Statistics

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

This Type of Illiteracy Could Hurt You via NYT

This Type of Illiteracy Could Hurt You

1 Health Literacy

of Older Adults:

Reshaping the Landscape

More than half of older Americans lack the skills to gather and understand medical information. Providers must simplify, researchers say.

NYT: 12.21.2018 by Paula Span

Every time her parents pick up a new prescription at a Walgreens in Houston, they follow Duyen Pham-Madden’s standing instructions: Use the iPad she bought for them, log onto FaceTime, hold up the pill bottles for her examination.

Her mother, 79, and father, 77, need numerous medications, but have trouble grasping when and how to take them.

The label may say to take one pill three times a day, but “my dad might take one a day,” said Ms. Pham-Madden, 56, an insurance purchasing agent in Blue Springs, Mo. “Or take three at a time.”

So she interprets the directions for them, also reminding her mother to take the prescribed megadose of vitamin D, for osteoporosis, only weekly, not daily.

Part of their struggle, Ms. Pham-Madden believes, stems from language barriers. The family emigrated from Vietnam in 1975, and while her parents speak and read English, they lack the fluency of native speakers.

But recently, Ms. Pham-Madden said, her father posed a question that anyone grappling with Medicare drug coverage might ask: “What’s the doughnut hole?”

Researchers refer to this type of knowledge as “health literacy,” meaning a person’s ability to obtain and understand the basic information neededto make appropriate health decisions [1].

Can someone read a pamphlet and then determine how often to undergo a particular medical test? Look at a graph and recognize a normal weight range for her height? Ascertain whether her insurance will cover a certain procedure?

Most American adults — 53 percent — have intermediate health literacy, a national survey found in 2006; they can perform "moderately challenging" activities [2], like reading denser texts and handling unfamiliar arithmetic.

Just 12 percent rank as “proficient,” the highest category. About a fifth have “basic” health literacy that could cause problems, and 14 percent score “below basic.” Health literacy differs by education level, race, poverty and other factors.

And it varies dramatically by age. While the proportion of adults with intermediate literacy ranges from 53 to 58 percent in other age groups, it falls to 38 percent among those 65 and older. The percentage of older adults with basic or below basic literacy is higher than in any other age group; only 3 percent qualify as proficient.  READ MORE >>

2 The Health Literacy of America’s Adults:

Results from the 2003 National Assessment of Adult Literacy, Healthy People 2020

Literacy Reports & Statistics

Health

Quick Guide to Health Literacy and Older Adults, US Dept HHS

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

Literacy programs teach an older generation how to read and write

Literacy programs teach an older generation how to read and write
TampaBay.com: May 26,2010 by Lane DeGregory

The conference room at the Pinellas Park Library is big and empty. The table is long. But the two women sit shoulder-to-shoulder, their heads nearly touching, each holding the edge of the same worn workbook. Ann Palmer, the woman on the left, slowly draws her polished fingernail beneath each word. Linda Barrett, the woman on the right, blinks behind her wire-rimmed bifocals. "The plants at the for … the for-est … the forest!" Linda reads. "Wow!" "Very good," Ann nods. "Keep going." "The plants at the forest floor are about a me … a me-ter high." Linda stops and looks at Ann, puzzled. "What's a me-ter?" For three years now, every Wednesday, for an hour-and-a-half, the women have been working together at the library. They're almost the same age, both mothers, both love the library. Though Linda used to hate it.

Ann, 56, is a former human resources manager who now volunteers full time as the head of the Literacy Council of St. Petersburg.

Linda, 58, used to live with her mom because she couldn't write a grocery list, couldn't dial 911, couldn't read.

Ann taught Linda how to hold a pencil so it wouldn't hurt her left hand, how to tell a B from a D by using her fists, how to write letters. Not just her name. All of them.

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For a long time, for 30 years, Linda says, it didn't matter. If you don't know what it means to read, if you don't know what you're missing, how can you care?

You pick up little tricks to fool people, to adapt: Study the first letter of street signs, learn PAR- means it's okay to park. In restaurants, when the menus don't have pictures, just order a hamburger. Even recipes sometimes have symbols, especially on the side of box mixes.

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Across America, an estimated 40 million adults have "below basic" literacy skills. The biggest group, according to the 2003 National Assessment of Adult Literacy, is people age 65 and older.

These are folks who can't decipher a bus schedule or fill out an insurance form, who can't pay a bill or use a map or read a prescription.

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In Pinellas County, Ann says, about 20 percent of adults are "below basic" readers. Her volunteer group, which started in 1968, gets students who have been referred from employers, social service agencies, homeless shelters. Volunteers teach reading and writing through the Laubach literacy program, a phonetic-based method pioneered in the Philippines during the 1930s.

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Linda's goals are simple: To read stories to her granddaughter. To figure out the TV listings so she won't miss her nature shows. To bake brownies that actually taste good. And she wants to know. "You know," she says. "Just know." READ MORE !