Health Literacy and Older Patients

Health literacy affects older adults in disproportionate numbers. Experts estimate that two out of three adults age 60 and over have either inadequate or marginal literacy skills.²

One study of 3,260 new Medicare enrollees found that overall, nearly 34 percent of English-speaking and nearly 54 percent of Spanish-speaking respondents had inadequate or marginal health literacy.¹⁸ And the National Adult Literacy Survey finds that 38 to 49 percent of women over 60 are in the lowest literacy level.¹⁹

"The consequences of low health literacy can be more serious in the elderly," says Sunil Kripalani, MD, a health literacy researcher at Emory University's School of Medicine in Atlanta, GA. One reason is that older adults have more chronic conditions than any other age group (about 80 percent of those 65 and older have at least one chronic condition and half have two). Thus, on average, someone with a chronic condition sees eight different physicians on average every year.⁵

That means older patients constantly have to get used to different health care professionals with different communication styles, which, in turn, affects their health. For instance, studies find that older people with health literacy problems are less likely to have ever had a flu vaccine, pneumonia vaccine, or Pap smear, or to have had a mammogram in the last two years.²⁰

"They may also have complex medication regimens, decreased visual acuity, diminished hearing, cognitive decline, physical limitations, live on a fixed income, and have limited access to new means of information retrieval such as the Internet," says Dr. Kripalani. "It's really a difficult situation."

One reason the elderly have more health literacy problems than younger patients may be related to their early education. Census data shows that fewer of today's older adults finished high school than the general population, with numbers even lower for older ethnic populations.²¹

Also, older people are often not welcomed into the health care system, notes E. Percil Stanford, PhD, who directs western regional operations for the AARP, and who previously directed the University Center on Aging at San Diego State University. "I don't think we've trained health care workers to be aware of the kind of signals they send." That includes failing to greet patients when they walk into the reception area, talking down to older patients, and addressing older patients by their first name. "A lot of people miss the fact that we're dealing with older people who are sensitive to being respected," he says. "Being called by their first name by strangers is degrading."

In addition to using an older patient's surname, he suggests health care professionals speak more slowly and loudly to older people, facing them so they can read lips and facial expressions. And because older people often have vision problems, any instructions should be written out in clear, large handwriting. Additionally, Dr. Stanford suggests medical professionals program more time for visits with older patients than younger ones. Extended office visits are an opportunity for health care professionals to review health information with their older clients, and for older patients to discuss their health concerns and their understanding of any medication instructions.

Because elderly patients are often taking multiple medications, which can be confusing to even those with high health literacy, he recommends limiting the number of medications prescribed whenever possible. "And be sure that someone else, a caregiver or family member, knows what the regimen is," says Dr. Sanford.

One way older people could increase their health literacy, some experts suggest, is by getting more health information over the Internet. But research finds that many Web sites targeting older adults are written for people with higher literacy levels and better eyesight.²²

To combat that problem, the National Institutes of Health runs its own health-related Web site specifically for older adults: http://www.nihseniorhealth.gov. The Web site's senior-friendly features include large print, short, easy-to-read segments of information and simple navigation. A "talking" function reads the text aloud and special buttons to enlarge the text or turn on high contrast make text more readable.X