We request to continue our ongoing, NIA cohort study (`LitCog'; R01AG030611). LitCog was designed to investigate associations between cognitive function and health literacy and how these factors affect performance on a range of common, health self-management tasks. Initially a cross-sectional study (LitCog I), 900 adults ages 55-74 were recruited in 2008 from 8 community-based, primary care practices in Chicago. Participants completed a series of comprehensive cognitive, psychological, social, behavioral, and health assessments (`T1' interview). We have now established a cohort with our first renewal (LitCog II), completing follow-up assessments every 3 years (T2, & T3; 78.2% retention rate). The objective of LitCog II has been to examine changes in cognitive function, health literacy, and self-management skills over 6 years, and their associations with patient-reported physical and mental health status. We have found: (1) cognitive function is strongly associated with health literacy - both factors decline over time (T1 to T3); (2) cognitive function and health literacy are associated with self-management skills and all are related to physical/mental health; (3) less-studied factors (e.g. patient activation, personality, technology use) may mediate/moderate associations. A final T4 assessment 10 years post-baseline is now proposed (LitCog III). This is an unprecedented opportunity to not only definitively learn whether cognitive function determines older adults' health literacy and self-management skills, but how these factors decline and impact health services use and outcomes over time. LitCog III is warranted for many reasons. First, with electronic access to medical/pharmacy records now at all sites (T1 to 1 year post T4), we can examine outcomes previously not possible due to limited resources, data availability, or insufficient follow-up time. Second, while decline in both cognitive function and health literacy is evident, the extent of decline is just emerging. Third, all participants hav a chronic illness, 77% have 2+, 60% have new diagnoses post-T1; effects of increasing disease/treatment burden on cognition, health literacy, and self-management skills has not been studied. Finally, 10 years of extended follow-up allows us to examine bi-directional associations between changes in cognitive function, health literacy, presence and clinical status of chronic disease.
Our specific aims are to:
Aim 1 Determine whether decline in cognitive function, health literacy and self-management skills over 10 years predict poorer health outcomes among older adults.
Aim 2 Assess whether decline in cognitive function, health literacy and self-management skills leads to excess healthcare resource use among older adults.
Aim 3 Identify less-studied factors that influence longitudinal associations between cognitive function, health literacy, self-management skills, and outcomes reported from Aims 1 and 2.

Public Health Relevance

The number of adults over 65 is expected to double by 2050. Health systems urgently must seek ways to support the many older adults contending with increasingly complex chronic disease self-management, in the face of declining cognitive resources that also is the result of aging. Our LitCog study will elucidate potentially modifiable, causal mechanisms linking cognitive decline to worse health that will aid in the design of effective, health system-led, health literacy & self-management interventions.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG030611-11
Application #
9459292
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
King, Jonathan W
Project Start
2007-09-15
Project End
2020-02-29
Budget Start
2018-03-01
Budget End
2019-02-28
Support Year
11
Fiscal Year
2018
Total Cost
Indirect Cost
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
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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
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
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
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
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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