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.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
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Special Emphasis Panel (ZRG1)
Program Officer
King, Jonathan W
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Northwestern University at Chicago
Internal Medicine/Medicine
Schools of Medicine
United States
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O'Conor, Rachel; Smith, Samuel G; Curtis, Laura M et al. (2018) Mild Visual Impairment and Its Impact on Self-Care Among Older Adults. J Aging Health 30:327-341
Wolf, Michael S; Smith, Samuel G; Pandit, Anjali U et al. (2018) Development and Validation of the Consumer Health Activation Index. Med Decis Making 38:334-343
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
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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
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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

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