Health literacy, cognitive ability, and functional health status among older adults.
OBJECTIVE
To investigate whether previously noted associations between health literacy and functional health status might be explained by cognitive function.


METHODS
Health Literacy and Cognition in Older Adults ("LitCog," prospective study funded by National Institute on Aging). Data presented are from interviews conducted among 784 adults, ages 55-74 years receiving care at an academic general medicine clinic or one of four federally qualified health centers in Chicago from 2008 to 2010.


METHODS
Study participants completed structured, in-person interviews administered by trained research assistants.


METHODS
Health literacy was measured using the Test of Functional Health Literacy in Adults, Rapid Estimate of Adult Literacy in Medicine, and Newest Vital Sign. Cognitive function was assessed using measures of long-term and working memory, processing speed, reasoning, and verbal ability. Functional health was assessed with SF-36 physical health summary scale and Patient Reported Outcomes Measurement Information System short form subscales for depression and anxiety.


RESULTS
All health literacy measures were significantly correlated with all cognitive domains. In multivariable analyses, inadequate health literacy was associated with worse physical health and more depressive symptoms. After adjusting for cognitive abilities, associations between health literacy, physical health, and depressive symptoms were attenuated and no longer significant.


CONCLUSIONS
Cognitive function explains a significant proportion of the associations between health literacy, physical health, and depression among older adults. Interventions to reduce literacy disparities in health care should minimize the cognitive burden in behaviors patients must adopt to manage personal health.
Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.
Marina
M
Serper
Rachel E
RE
Patzer
Laura M
LM
Curtis
Samuel G
SG
Smith
Rachel
R
O'Conor
David W
DW
Baker
Michael S
MS
Wolf
D000203:Activities of Daily Living; D000368:Aged; D002641:Chicago; D003071:Cognition; D005260:Female; D057220:Health Literacy; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D036301:Qualitative Research; D011795:Surveys and Questionnaires
Health literacy; cognitive abilities; health tasks; mental health; patient-reported outcomes; physical health