Health Literacy in Geriatric Patients

Official title

A Comparison of Health Literacy Estimates Among Patients, Caregivers and a Geriatric Team

Overview

Health Literacy is one's ability to understand health information well enough to make informed decisions about their health. Limited health literacy makes it hard for people to understand complex health issues and follow health care recommendations. Limited health literacy is associated with adverse health outcomes such as higher mortality, increased risk of emergency department visits and hospital admissions leading to higher medical costs. Although there are tools to assess health literacy, they are not widely used, so many healthcare providers do not measure their patients' health literacy levels adequately. Health care workers tend to overestimate their patients' health literacy. This is especially important for older adults who often have memory problems and multiple illnesses. This study will evaluate how doctors and team members in a geriatric clinic estimate their patient's health literacy and determine if this matches with the patients' health literacy as measured by a simple validated questionnaire. The investigators will also look at how a patient's relative or caregiver estimates their health literacy using a similar short questionnaire. The research team plans to follow up with a telephone call in 6 months, to see which health concerns if any have occurred since the clinic visit.

Detailed description

As treatments become more sophisticated and the healthcare system becomes more complex, health literacy (HL) assumes an ever-greater importance in the therapeutic alliance between healthcare professionals and patients.

Limited health literacy causes difficulty in understanding one's health condition. As a result, it is associated with less adherence to self-care behaviours, increased mortality, increased hospitalizations, other adverse health outcomes, and high healthcare costs. In those over aged 65, health literacy is positively influenced by levels of educational attainment and literacy practices in the home, male gender, and weakly by informal learning and self-study and adult education experience. Negative associations include being foreign-born and failure to learn from exposure to various contexts. Understanding the health literacy of patients is particularly vital for geriatricians as older adults referred to geriatric medicine clinics already experience barriers to high quality care due to the frequent presence of cognitive impairment and multiple comorbidities.

The interaction among these variables and health literacy in a tertiary care setting for older adults with cognitive impairment remains under-explored. Given the dependent state of many cognitively impaired individuals, the responsibility lies with geriatricians to adjust their communication and care strategies according to the HL levels of their patients. Studying the association between the accuracy of geriatrician-perceived HL and health outcomes could reveal the extent to which physician communication impacts these outcomes. Given these intertwined factors, a 6-month follow-up is crucial to capture the longitudinal associations of HL on patient outcomes, providing a more comprehensive picture of how these variables interact over time.

This study's primary outcome is the evaluation of patient health literacy and the level of agreement between the geriatric team's perception and objectively measured health literacy. The secondary outcome is assessing how patient health literacy is associated with medication adherence and future planning. As well, the investigators hope to assess how patient health literacy is associated with emergency department visits, hospitalizations, hospital length of stay, remaining home, long-term care admission and mortality within 6 months.

Primary outcome measures

• Patient self-identified HL [Time frame: At enrollment]
• Caregiver's perception of patient's HL [Time frame: At enrollment]
• Patient self-identified quality of life [Time frame: At enrollment]
• Geriatric Team's assessment of patient's HL [Time frame: At enrollment]

Secondary outcome measures (12)

• Medication adherence [Time frame: At enrollment]
• Number of participants with existing community home care planning [Time frame: At enrollment]
• Number of participants with long-term care planning [Time frame: At enrollment]
• Number of patients with code status discussion [Time frame: At enrollment]
• Power of Attorney designation [Time frame: At enrollment]
• Number of patients remaining home [Time frame: At enrollment]
• Falls [Time frame: At enrollment]
• Number of ED visits [Time frame: 6 months]
• Number of hospitalizations [Time frame: 6 months]
• Hospital length of stay [Time frame: 6 months]
• Long-term care admission [Time frame: 6 months]
• Mortality [Time frame: 6 months]

Eligibility criteria

Inclusion criteria

• Patients (both new and follow up) attending St. Peter's Hospital Geriatric Clinic
• Willingness to participate in the study (caregiver can rate HL for patient if patient unable to)
• Consenting to study (by patient or caregiver)

Exclusion criteria

• Behavior (e.g. behavioral and psychological symptoms of dementia) which may be aggravated by additional questions
• Acute illness preventing participation
• Terminal illness that would prevent 6-month telephone follow up
• Previous participation in this study

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Observational model

Other

Study locations

Canada · 1 center

• St. Peter's Geriatric Clinic — Hamilton

Publications

• Kobayashi LC, Wardle J, von Wagner C. Internet use, social engagement and health literacy decline during ageing in a longitudinal cohort of older English adults. J Epidemiol Community Health. 2015 Mar;69(3):278-83. doi: 10.1136/jech-2014-204733. Epub 2014 Nov 26. PMID 25428933
• Chesser AK, Keene Woods N, Smothers K, Rogers N. Health Literacy and Older Adults: A Systematic Review. Gerontol Geriatr Med. 2016 Mar 15;2:2333721416630492. doi: 10.1177/2333721416630492. eCollection 2016 Jan-Dec. PMID 28138488
• Lu J, Sun S, Gu Y, Li H, Fang L, Zhu X, Xu H. Health literacy and health outcomes among older patients suffering from chronic diseases: A moderated mediation model. Front Public Health. 2023 Jan 10;10:1069174. doi: 10.3389/fpubh.2022.1069174. eCollection 2022. PMID 36703841
• Li H, Tao S, Sun S, Xiao Y, Liu Y. The relationship between health literacy and health-related quality of life in Chinese older adults: a cross-sectional study. Front Public Health. 2024 Mar 20;12:1288906. doi: 10.3389/fpubh.2024.1288906. eCollection 2024. PMID 38572002
• Geboers B, Uiters E, Reijneveld SA, Jansen CJM, Almansa J, Nooyens ACJ, Verschuren WMM, de Winter AF, Picavet HSJ. Health literacy among older adults is associated with their 10-years' cognitive functioning and decline - the Doetinchem Cohort Study. BMC Geriatr. 2018 Mar 20;18(1):77. doi: 10.1186/s12877-018-0766-7. PMID 29558890
• Suppiah SD, Malhotra R, Tan YW, Jessup RL, Chew LST, Tang WE, Beauchamp A. Prevalence of health literacy and its correlates from a national survey of older adults. Res Social Adm Pharm. 2023 Jun;19(6):906-912. doi: 10.1016/j.sapharm.2023.02.013. Epub 2023 Feb 27. PMID 36898905
• Wang Q, Fan K, Li P. Effect of the Use of Home and Community Care Services on the Multidimensional Health of Older Adults. Int J Environ Res Public Health. 2022 Nov 21;19(22):15402. doi: 10.3390/ijerph192215402. PMID 36430119
• Jin H, Kim Y, Rhie SJ. Factors affecting medication adherence in elderly people. Patient Prefer Adherence. 2016 Oct 19;10:2117-2125. doi: 10.2147/PPA.S118121. eCollection 2016. PMID 27799748

Identifiers

NCT: NCT06971393 · 17823

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗