Change in Health Literacy over a Decade in a Prospective Cohort of Community-Dwelling Older Adults

Laura M. Curtis; Mary J. Kwasny; Lauren Opsasnick; Rachel M. O’Conor; Julia Yoshino-Benavente; Morgan Eifler; Alex D. Federman; Drew Altschul; Michael S. Wolf

doi:10.1007/s11606-020-06423-8

Change in Health Literacy over a Decade in a Prospective Cohort of Community-Dwelling Older Adults

Laura M. Curtis^*, Mary J. Kwasny, Lauren Opsasnick, Rachel M. O’Conor, Julia Yoshino-Benavente, Morgan Eifler, Alex D. Federman, Drew Altschul, Michael S. Wolf

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

16 Scopus citations

Abstract

Background: Health literacy is often viewed as a static trait in longitudinal studies, which may over or underestimate an individual’s ability to manage one’s health. Objectives: We sought to examine health literacy over time among older adults using three widely used measures. Design: A prospective cohort study. Participants: Community-dwelling adults ages 55 to 74 at baseline with at least one follow-up visit (N = 656) recruited from one academic internal medicine clinic and six community health centers in Chicago, IL. Measures: Health literacy was measured using the Test of Functional Health Literacy in Adults (TOFHLA), Newest Vital Sign (NVS), and Rapid Estimate of Adult Literacy in Medicine (REALM) at baseline and up to three follow-up time points. Results: In unadjusted analyses, significant changes since baseline were found beginning at the second follow-up (mean (M) = 6.0 years, SD = 0.6) for the TOFHLA (M = − 0.9, SD = 0.95, p = 0.049) and the REALM (M = 0.3, SD = 2.5, p = 0.004) and at the last follow-up (M = 8.6 years, SD = 0.5) for the NVS (M = − 0.2, SD = 1.4, p = 0.02). There were non-linear effects of baseline age on TOFHLA and NVS scores over time (piecewise cubic spline p = 0.01 and p < 0.001, respectively) and no effect on REALM scores (B = 0.02, 95% CI − 0.01 to 0.04, p = 0.17) using multivariable mixed-effects linear regression models, controlling for race, education, income, and comorbidity. Conclusion: We found a negative relationship between age and health literacy over time as measured by the TOFHLA and NVS. Health literacy barriers appear to be more prevalent among individuals in later life, when self-care demands are similarly increasing. Clinicians might consider strategies to assess and respond to limited health literacy, particularly among patients 70 and older. REALM performance remained stable over 10 years of follow-up. This questions whether health literacy tools measure the same attribute. Prospective health literacy studies should carefully consider what measures to use, depending on their objective.

Original language	English (US)
Pages (from-to)	916-922
Number of pages	7
Journal	Journal of general internal medicine
Volume	36
Issue number	4
DOIs	https://doi.org/10.1007/s11606-020-06423-8
State	Published - Apr 2021

Funding

The study was financially supported by the National Institutes of Health (R01AG030611) and the Agency for Healthcare Research and Quality (R01HL116630). Dr. Wolf reports grants and personal fees from Pfizer, personal fees from Sanofi, grants from Merck, grants from Eli Lilly, grants from Amgen, personal fees from Luto UK, personal fees from MedLearning Group, and grants from Gordon And Betty Moore Foundation, outside the submitted work. No other authors reported conflicts of interest. This research was supported by the National Institute of Aging (R01AG030611) and the Agency for Healthcare Research and Quality (R01HL116630). The funders had no role in the design, conduct, study analysis, or the decision to submit the manuscript for publication.

Keywords

aging
cognition
health literacy
prospective
self-management

ASJC Scopus subject areas

Internal Medicine

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10.1007/s11606-020-06423-8

Cite this

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title = "Change in Health Literacy over a Decade in a Prospective Cohort of Community-Dwelling Older Adults",

abstract = "Background: Health literacy is often viewed as a static trait in longitudinal studies, which may over or underestimate an individual{\textquoteright}s ability to manage one{\textquoteright}s health. Objectives: We sought to examine health literacy over time among older adults using three widely used measures. Design: A prospective cohort study. Participants: Community-dwelling adults ages 55 to 74 at baseline with at least one follow-up visit (N = 656) recruited from one academic internal medicine clinic and six community health centers in Chicago, IL. Measures: Health literacy was measured using the Test of Functional Health Literacy in Adults (TOFHLA), Newest Vital Sign (NVS), and Rapid Estimate of Adult Literacy in Medicine (REALM) at baseline and up to three follow-up time points. Results: In unadjusted analyses, significant changes since baseline were found beginning at the second follow-up (mean (M) = 6.0 years, SD = 0.6) for the TOFHLA (M = − 0.9, SD = 0.95, p = 0.049) and the REALM (M = 0.3, SD = 2.5, p = 0.004) and at the last follow-up (M = 8.6 years, SD = 0.5) for the NVS (M = − 0.2, SD = 1.4, p = 0.02). There were non-linear effects of baseline age on TOFHLA and NVS scores over time (piecewise cubic spline p = 0.01 and p < 0.001, respectively) and no effect on REALM scores (B = 0.02, 95% CI − 0.01 to 0.04, p = 0.17) using multivariable mixed-effects linear regression models, controlling for race, education, income, and comorbidity. Conclusion: We found a negative relationship between age and health literacy over time as measured by the TOFHLA and NVS. Health literacy barriers appear to be more prevalent among individuals in later life, when self-care demands are similarly increasing. Clinicians might consider strategies to assess and respond to limited health literacy, particularly among patients 70 and older. REALM performance remained stable over 10 years of follow-up. This questions whether health literacy tools measure the same attribute. Prospective health literacy studies should carefully consider what measures to use, depending on their objective.",

keywords = "aging, cognition, health literacy, prospective, self-management",

author = "Curtis, {Laura M.} and Kwasny, {Mary J.} and Lauren Opsasnick and O{\textquoteright}Conor, {Rachel M.} and Julia Yoshino-Benavente and Morgan Eifler and Federman, {Alex D.} and Drew Altschul and Wolf, {Michael S.}",

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doi = "10.1007/s11606-020-06423-8",

language = "English (US)",

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AU - Curtis, Laura M.

AU - Kwasny, Mary J.

AU - Opsasnick, Lauren

AU - O’Conor, Rachel M.

AU - Yoshino-Benavente, Julia

AU - Eifler, Morgan

AU - Federman, Alex D.

AU - Altschul, Drew

AU - Wolf, Michael S.

PY - 2021/4

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N2 - Background: Health literacy is often viewed as a static trait in longitudinal studies, which may over or underestimate an individual’s ability to manage one’s health. Objectives: We sought to examine health literacy over time among older adults using three widely used measures. Design: A prospective cohort study. Participants: Community-dwelling adults ages 55 to 74 at baseline with at least one follow-up visit (N = 656) recruited from one academic internal medicine clinic and six community health centers in Chicago, IL. Measures: Health literacy was measured using the Test of Functional Health Literacy in Adults (TOFHLA), Newest Vital Sign (NVS), and Rapid Estimate of Adult Literacy in Medicine (REALM) at baseline and up to three follow-up time points. Results: In unadjusted analyses, significant changes since baseline were found beginning at the second follow-up (mean (M) = 6.0 years, SD = 0.6) for the TOFHLA (M = − 0.9, SD = 0.95, p = 0.049) and the REALM (M = 0.3, SD = 2.5, p = 0.004) and at the last follow-up (M = 8.6 years, SD = 0.5) for the NVS (M = − 0.2, SD = 1.4, p = 0.02). There were non-linear effects of baseline age on TOFHLA and NVS scores over time (piecewise cubic spline p = 0.01 and p < 0.001, respectively) and no effect on REALM scores (B = 0.02, 95% CI − 0.01 to 0.04, p = 0.17) using multivariable mixed-effects linear regression models, controlling for race, education, income, and comorbidity. Conclusion: We found a negative relationship between age and health literacy over time as measured by the TOFHLA and NVS. Health literacy barriers appear to be more prevalent among individuals in later life, when self-care demands are similarly increasing. Clinicians might consider strategies to assess and respond to limited health literacy, particularly among patients 70 and older. REALM performance remained stable over 10 years of follow-up. This questions whether health literacy tools measure the same attribute. Prospective health literacy studies should carefully consider what measures to use, depending on their objective.

AB - Background: Health literacy is often viewed as a static trait in longitudinal studies, which may over or underestimate an individual’s ability to manage one’s health. Objectives: We sought to examine health literacy over time among older adults using three widely used measures. Design: A prospective cohort study. Participants: Community-dwelling adults ages 55 to 74 at baseline with at least one follow-up visit (N = 656) recruited from one academic internal medicine clinic and six community health centers in Chicago, IL. Measures: Health literacy was measured using the Test of Functional Health Literacy in Adults (TOFHLA), Newest Vital Sign (NVS), and Rapid Estimate of Adult Literacy in Medicine (REALM) at baseline and up to three follow-up time points. Results: In unadjusted analyses, significant changes since baseline were found beginning at the second follow-up (mean (M) = 6.0 years, SD = 0.6) for the TOFHLA (M = − 0.9, SD = 0.95, p = 0.049) and the REALM (M = 0.3, SD = 2.5, p = 0.004) and at the last follow-up (M = 8.6 years, SD = 0.5) for the NVS (M = − 0.2, SD = 1.4, p = 0.02). There were non-linear effects of baseline age on TOFHLA and NVS scores over time (piecewise cubic spline p = 0.01 and p < 0.001, respectively) and no effect on REALM scores (B = 0.02, 95% CI − 0.01 to 0.04, p = 0.17) using multivariable mixed-effects linear regression models, controlling for race, education, income, and comorbidity. Conclusion: We found a negative relationship between age and health literacy over time as measured by the TOFHLA and NVS. Health literacy barriers appear to be more prevalent among individuals in later life, when self-care demands are similarly increasing. Clinicians might consider strategies to assess and respond to limited health literacy, particularly among patients 70 and older. REALM performance remained stable over 10 years of follow-up. This questions whether health literacy tools measure the same attribute. Prospective health literacy studies should carefully consider what measures to use, depending on their objective.

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Change in Health Literacy over a Decade in a Prospective Cohort of Community-Dwelling Older Adults

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