Self-management behaviors in older adults with asthma: associations with health literacy.
OBJECTIVE
To examine self-management behaviors, including medication adherence and inhaler technique, in older adults with asthma and their association with health literacy.


METHODS
Observational cohort study.


METHODS
Primary care and pulmonary specialty practices in two tertiary academic medical centers and three federally qualified health centers in New York, New York, and Chicago, Illinois.


METHODS
Adults with moderate or severe persistent asthma aged 60 and older (N = 433).


METHODS
Outcomes were adherence to asthma controller medications, metered dose inhaler (MDI) and dry powder inhaler (DPI) techniques, having a usual asthma physician, and avoidance of four common triggers. Health literacy was assessed using the Short Test of Functional Health Literacy in Adults.


RESULTS
The mean age was 67, and 36% of participants had marginal or low health literacy. Adherence was low (38%) overall and worse in individuals with low health literacy (22%) than in those with adequate literacy (47%, P < .001) and after adjusting for demographic factors and health status (odds ratio (OR) = 0.48, 95% confidence interval (CI) = 0.31-0.73). Similarly, inhaler technique was poor; only 38% and 54% had good MDI and DPI technique, respectively. Technique was worse in those with low health literacy (MDI technique: OR = 0.57, 95% CI = 0.38-0.85; DPI technique: OR = 0.42, 95% CI = 0.25-0.71). Asthma self-monitoring and avoidance of triggers occurred infrequently but were less consistently associated with low health literacy.


CONCLUSIONS
Adherence to medications and inhaler technique are poor in older adults with asthma and worse in those with low health literacy. Clinicians should routinely assess controller medication adherence and inhaler technique and use low-literacy communication strategies to support self-management in older adults with asthma.
Division of General Internal Medicine, Icahn School of Medicine, Mount Sinai, New York, New York.
Alex D
AD
Federman
Michael S
MS
Wolf
Anastasia
A
Sofianou
Melissa
M
Martynenko
Rachel
R
O'Connor
Ethan A
EA
Halm
Howard
H
Leventhal
Juan P
JP
Wisnivesky
D000280:Administration, Inhalation; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D057220:Health Literacy; D006304:Health Status; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D011446:Prospective Studies; D012648:Self Care / Q000379:methods*; D011795:Surveys and Questionnaires
D018927:Anti-Asthmatic Agents
adherence; asthma; elderly; health literacy; inhaler technique; self-management