Health Status and Health Literacy in Older Adults
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This study aimed to examine the relationship between health literacy and the health status of older adults. The first section of the study consisted of a comprehensive literature review of prior research regarding cognitive, health, and behavioral factors associated with functional health literacy in older adults. Factors in older adults that influence health literacy include: demographics, including age, race, socioeconomic status, and education; cognitive abilities; health and disease knowledge; health beliefs including mistrust of traditional and nontraditional medicine; reading levels; communication skills; social support; healthcare access; preventive care behaviors; and hospitalizations. The second section of the study involved a comprehensive review of instruments testing health literacy. Most instruments testing health literacy revolve around medical term recognition and are based on clinical experiences and not on the practical application of using health knowledge to maintain and improve one’s health. Instruments examined include the REALM, REALM-R, TOFHLA, S-TOFHLA, MART, NVS, DAHL, SAHLSA, OHLI, and screening questions. The most widely used instrument at this time is the S-TOFHLA and most of the newer instruments use it as the standard when testing their validity. The third section of this study used primary data to examine health literacy, patient activation and health status in older adults. The study participants were older adults (n=533) recruited from senior centers, aging programs, and churches in southeast Texas between 2010 and 2012. Participants completed a survey regarding demographics and health status, functional health literacy and the shortened Patient Activation Measure. Using multivariate linear regression, health literacy was related to mental health (β= –.191, p<.000) and number of days of limited physical activities (β= –.123, p=.019); patient activation was related to overall general self-reported health status (β= –.234, p<.000) and number of days of limited physical activity (β= –.159, p<.001); and the interaction was related to poor physical health β= –.994, p<.000). The only statistically significant relationship with the interaction of the two was with the number of days of limited physical activity. Health literacy is related to the health status of older adults but better instruments are needed to more accurately assess levels of functional health literacy, especially in older adults. Patient activation is also related to the health status of older adults but the only statically significant relationship between the interaction of patient activation and health literacy was with the number of days of limited physical activity.
Fulton, Daphne Saxon (2014). Health Status and Health Literacy in Older Adults. Doctoral dissertation, Texas A & M University. Available electronically from