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Improving health literacy in elderly patients may enhance health status and reduce use of health care services

Health literacy directly affects a person's health status and health care use, suggests a new study. Researchers explored four intermediate factors that may link health literacy and health status and use: disease knowledge, health behavior, preventive care, and compliance. Contrary to their hypothesis, they found that health literacy was directly and positively linked to self-related health status and directly and negatively linked to hospitalization and emergency room use. Aside from health literacy, health behavior was the only variable found to be significantly correlated with perceived health status.

The researchers interviewed 489 elderly Medicare patients, most of whom were female (78.7 percent) and black (59.1 percent) with a high school education. To measure health literacy, the researchers used the Short Test of Functional Health Literacy in Adults (S-TOFHLA). To measure the intermediate factors, they asked questions about chronic diseases, exercise, nutrition, and health responsibility; screening tests; and medication compliance. Health status was measured on a five-point scale from poor to excellent. Health care utilization was measured by the number of emergency room visits and hospital admissions in the previous year. Educational attainment, frequently used as a proxy measure of health literacy, had indirect effects that were mediated via increased health literacy.

The researchers suggest that improving health literacy may be the most effective and direct approach to improving the health status and reducing hospital and emergency room use among elderly patients. They also recommend that the health care system be made more accessible to adults with low health literacy. This could be accomplished by designing more reader-friendly media with simple illustrations and culturally sensitive examples and enhancing patients' understanding of health information by communicating in simpler language and with simple instructions. This study was supported by the Agency for Healthcare Research and Quality (HS13004).

See "Effects of health literacy on health status and health service utilization amongst the elderly" by Young Ik Cho, Ph.D., Shoou-Yih D. Lee, Ph.D., Ahsan M. Arozullah, M.D., and Kathleen S. Crittenden, Ph.D. in the Social Science and Medicine 66, pp.1809-1816, 2008.

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