We propose to extend our current health literacy investigation ['LitCog';R01AG030611] and evaluate the association between literacy skills, cognitive function, and health outcomes over time among an established cohort of community-dwelling, older adults. An increasing number of investigators are questioning whether cognitive function might explain why adults with low 'health literacy'experience poorer health. Our team is currently conducting an NIA-funded, cross-sectional study, "Health Literacy and Cognitive Function among Older Adults" (a.k.a. 'LitCog'). The objective is to investigate the relationship between health literacy and cognitive function, and to determine how these factors predict performance on common health tasks. We now propose to follow-up LitCog participants (N=1100) and examine the association between literacy, cognitive function, performance on common health tasks, and health status over a 5-year period. A longitudinal study will provide an in-depth investigation of older adults'health literacy skills, and how their ability to manage health is affected by cognitive decline and the aging process. The proposed cohort study will improve our understanding of: 1) the true barriers underlying the problem of low health literacy, and 2) how best to inform present and future intervention strategies. Our primary study aims are to: 1) Determine whether older adults'health literacy skills change over time, and if these changes are associated with a decline in cognitive function;2) Evaluate the association between health literacy, cognitive function, and health status among older adults;3) Investigate psychosocial factors that potentially mediate or moderate the association between literacy skills, cognitive function, and health status among older adults;and our secondary aim is to: 4) Explore strategies to enhance older adults'performance on health tasks that mostly rely on fluid cognitive abilities. We will conduct follow-up interviews (T2 - 2.5 years;T3 - 5 years post-baseline interview) with older adults who previously participated in the LitCog study;administering the same health literacy, cognitive function, and health status measures given in the baseline battery.
In Aim 4, we will embed a series of controlled, cross-sectional experiments to test specific strategies to increase older adults'performance on complex health tasks.

Public Health Relevance

The extent and association between limited literacy and poor health outcomes has been repeatedly documented, yet specific causal pathways are not entirely clear. The proposed longitudinal study will provide an in-depth investigation of older adults'health literacy and ability to manage health, and whether these skills are affected by cognitive decline and the aging process. Our research will improve our understanding of the true barriers underlying the problem of low health literacy, and how best to inform present and future intervention strategies.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG030611-06
Application #
8423763
Study Section
Special Emphasis Panel (ZRG1-RPHB-A (50))
Program Officer
King, Jonathan W
Project Start
2007-09-15
Project End
2016-02-29
Budget Start
2013-04-01
Budget End
2014-02-28
Support Year
6
Fiscal Year
2013
Total Cost
$540,044
Indirect Cost
$167,101
Name
Northwestern University at Chicago
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
005436803
City
Chicago
State
IL
Country
United States
Zip Code
60611
Kobayashi, Lindsay C; Wardle, Jane; Wolf, Michael S et al. (2016) Aging and Functional Health Literacy: A Systematic Review and Meta-Analysis. J Gerontol B Psychol Sci Soc Sci 71:445-57
Bailey, Stacy Cooper; Fang, Gang; Annis, Izabela E et al. (2015) Health literacy and 30-day hospital readmission after acute myocardial infarction. BMJ Open 5:e006975
Kobayashi, Lindsay C; Smith, Samuel G; O'Conor, Rachel et al. (2015) The role of cognitive function in the relationship between age and health literacy: a cross-sectional analysis of older adults in Chicago, USA. BMJ Open 5:e007222
Curtis, Laura M; Revelle, William; Waite, Katherine et al. (2015) Development and validation of the comprehensive health activities scale: a new approach to health literacy measurement. J Health Commun 20:157-64
Smith, Samuel G; O'Conor, Rachel; Aitken, William et al. (2015) Disparities in registration and use of an online patient portal among older adults: findings from the LitCog cohort. J Am Med Inform Assoc 22:888-95
Bailey, Stacy C; O'Conor, Rachel; Bojarski, Elizabeth A et al. (2015) Literacy disparities in patient access and health-related use of Internet and mobile technologies. Health Expect 18:3079-87
Smith, Samuel G; O'Conor, Rachel; Curtis, Laura M et al. (2015) Low health literacy predicts decline in physical function among older adults: findings from the LitCog cohort study. J Epidemiol Community Health 69:474-80
Smith, Samuel G; Curtis, Laura M; O'Conor, Rachel et al. (2015) ABCs or 123s? The independent contributions of literacy and numeracy skills on health task performance among older adults. Patient Educ Couns 98:991-7
Serper, Marina; Patzer, Rachel E; Curtis, Laura M et al. (2014) Health literacy, cognitive ability, and functional health status among older adults. Health Serv Res 49:1249-67
Dahlke, Allison R; Curtis, Laura M; Federman, Alex D et al. (2014) The mini mental status exam as a surrogate measure of health literacy. J Gen Intern Med 29:615-20

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