We request to continue our NIA cohort study (?LitCog?; R01AG030611). LitCog studies the confluence of increased medical morbidity resulting in complex patient self-management (SM) roles, and cognitive decline, which may affect older patients? health literacy (HL) skills and chronic illness self-care. Functionally independent, ?cognitively normal? adults ages 55-74 (N=900) were recruited from community primary care practices in Chicago. Participants have completed comprehensive cognitive, psychological, social, behavioral, and functional health assessments every 3 years (4 interviews; 2008-2018). The sample is diverse by race, socioeconomic status and medical morbidity; uncommon among cognitive aging studies. A 1st renewal award (LitCog II) examined changes in cognition, HL and SM skills over 6 years and their associations with physical and mental health. We found cognitive function to be strongly associated with HL; both decline together over time. Cognitive function and HL also determine older adults? SM skills; all predict functional health status and its decline. A 2nd renewal (LitCog III) has allowed us to capture new health behaviors, chronic disease outcomes, and healthcare use from medical, pharmacy records a decade post-baseline. Cognitive function, HL and SM skills impact all of these outcomes. LitCog III is almost complete; 774 of 900 (86%) subjects are alive and available for further study. We now propose to conduct follow-up assessments 12 and 15 years post-baseline (LitCog IV). With 6 interviews over 15 years, specific trajectories of decline in cognition, HL, SM skills and health status can be closely studied. The prevalence of and adjustment to increasing morbidity, disability, cognitive impairment (including Alzheimer?s Disease & Related Dementias (ADRD)) allow for new outcomes for investigation. Mortality data will also now be available with extended follow-up. Our primary aim is to 1) evaluate trajectories in cognitive function, HL and SM skills over 15 years among older adults, and their associations with health outcomes. LitCog is an exceptionally unique cognitive aging cohort study as it is framed in the context of health services research. Our goal has been to inform health system strategies for effectively managing older patients by understanding how cognition changes and influences HL and SM skills necessary for achieving optimal health. Modifiable factors that may mediate/moderate associations are also explored as potential intervention targets. The involvement and roles of caregivers has specifically emerged as an important social determinant of patients? health. An administrative ADRD supplement (LitCog IIIA) has expanded our inquiry by including interviews with caregivers (informal or paid) involved in supporting the care of 60% of participants. In LitCog IV, we will create a parallel caregiver cohort, with the secondary aims to 2) investigate associations between the presence of an involved caregiver with treatment adherence, chronic disease outcomes, and functional health status among older adults; 3) identify factors influencing associations between caregiver involvement and patient outcomes.

Public Health Relevance

As the number of adults over 65 is expected to double by 2050, health systems must urgently seek ways to support the many older adults managing not just one but multiple chronic conditions, while contending with cognitive decline as the result of aging. Our LitCog IV study has the unique ability to elucidate potentially modifiable, causal mechanisms linking cognitive decline and impairment to worse health; with a particular focus on the optimal involvement of caregivers. Findings will directly guide the design of effective health system interventions to support the primary care management of a diverse, older patient population.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
2R01AG030611-13
Application #
9817486
Study Section
Clinical Management of Patients in Community-based Settings Study Section (CMPC)
Program Officer
King, Jonathan W
Project Start
2007-09-15
Project End
2025-02-28
Budget Start
2020-03-01
Budget End
2021-02-28
Support Year
13
Fiscal Year
2020
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
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
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
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
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
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
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

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