title: Internet use, social engagement and health literacy decline during ageing in a longitudinal cohort of older English adults.
abstract: BACKGROUND
  Health literacy skills tend to decline during ageing, which is often attributed to age-related cognitive decline. Whether health literacy skills may be influenced by technological and social factors during ageing is unknown.
  
  
  METHODS
  We investigated whether internet use and social engagement protect against health literacy decline during ageing, independent of cognitive decline. We used prospective data from 4368 men and women aged ≥52 years in the English Longitudinal Study of Ageing from 2004 to 2011. Health literacy was measured at baseline (2004-2005) and at follow-up (2010-2011) using a reading comprehension test of a fictitious medicine label. The influences of consistent internet use and engagement in each of the civic, leisure and cultural activities on health literacy decline over the follow-up were estimated.
  
  
  RESULTS
  After adjusting for cognitive decline and other covariates, consistent internet use (1379/4368; 32%) was protectively associated with health literacy decline (OR=0.77; 95% CI 0.60 to 0.99), as was consistent engagement in cultural activities (1715/4368; 39%; OR=0.73; 95% CI 0.56 to 0.93). As the number of activities engaged in increased, the likelihood of health literacy decline steadily decreased (ptrend<0.0001), with OR=0.51 (95% CI 0.33 to 0.79) for engaging in all four of the internet use and civic, leisure and cultural activities versus none.
  
  
  CONCLUSIONS
  Internet use and social engagement, particularly in cultural activities (eg, attending the cinema, art galleries, museums and the theatre), may help older adults to maintain health literacy during ageing. Support for older adults to maintain socially engaged lives and to access the internet should help promote the maintenance of functional literacy skills during ageing.
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Lindsay C
authors.identifier: http://orcid.org/0000-0003-2725-3107
authors.initials: LC
authors.lastname: Kobayashi
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Christian
authors.initials: C
authors.lastname: von Wagner
mesh_terms: D000203:Activities of Daily Living; D000066492:Cognitive Aging / Q000502:physiology* / Q000523:psychology*; D004522:Educational Status; D004739:England; D056344:Executive Function; D005260:Female; D057220:Health Literacy; D006304:Health Status; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008569:Memory Disorders; D008875:Middle Aged; D012919:Social Behavior; D012923:Social Class
keywords: AGEING; COGNITION; LONGITUDINAL STUDIES; SOCIAL INEQUALITIES; Social activities