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The Association Between Age and Health Literacy Among Elderly Persons

^a Center for Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio
^b Department of Medicine and Department of Epidemiology-Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio
^c United States Quality Algorithms Center for Health Care Research^TM, Atlanta, Georgia
^d Departments of Neurology and Psychiatry, Case Western Reserve University School of Medicine and the Case Western Reserve University Alzheimer Center, University Hospitals of Cleveland, Ohio

David W. Baker, MetroHealth Medical Center, 2500 MetroHealth Drive, Rammelkamp 221, Cleveland, OH 44109-1998 E-mail: dwb{at}po.cwru.edu.

Objective. To examine why older age groups have worse functional health literacy.

Methods. Home interviews were conducted with community-dwelling elderly persons (n = 2,774) to determine demographics, years of school completed, newspaper reading frequency, chronic diseases, and health status. Participants completed the Short Test of Functional Health Literacy in Adults (S-TOFHLA, range 0–100) and the Mini Mental State Examination (MMSE).

Results. Mean S-TOFHLA scores declined 1.4 points (95% CI 1.3–1.5) for every year increase in age (p < .001). After adjusting for sex, race, ethnicity, and education, the S-TOFHLA score declined 1.3 points (95% CI 1.2–1.4) for every year increase in age. Even after adjustment for performance on the MMSE, the S-TOFHLA score declined 0.9 points (95% CI 0.8–1.0) for every year increase in age (p < .001). Differences in newspaper reading frequency, visual acuity, chronic medical conditions, and health status, did not explain the lower literacy of older participants.

Discussion. Functional health literacy was markedly lower among older age groups even after adjusting for differences in MMSE performance, newspaper reading frequency, health status, and visual acuity. Future studies should prospectively examine whether functional literacy declines with age and whether this is explained by declines in cognitive function.

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