Get access

Health Literacy and Cognitive Performance in Older Adults

Authors

  • Alex D. Federman MD, MPH,

    1. From the *Division of General Internal Medicine, Department of Psychiatry, Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New YorkGeriatric Research, Education, and Clinical Center, Bronx Veterans Affairs Medical Center, Bronx, New York§The Health Literacy and Learning Program, Division of General Internal Medicine, Northwestern University, Chicago, Illinois; and #Division of General Internal Medicine, University of Texas, Southwestern, Dallas, Texas.
    Search for more papers by this author
  • Mary Sano PhD,

    1. From the *Division of General Internal Medicine, Department of Psychiatry, Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New YorkGeriatric Research, Education, and Clinical Center, Bronx Veterans Affairs Medical Center, Bronx, New York§The Health Literacy and Learning Program, Division of General Internal Medicine, Northwestern University, Chicago, Illinois; and #Division of General Internal Medicine, University of Texas, Southwestern, Dallas, Texas.
    Search for more papers by this author
  • Michael S. Wolf PhD, MPH,

    1. From the *Division of General Internal Medicine, Department of Psychiatry, Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New YorkGeriatric Research, Education, and Clinical Center, Bronx Veterans Affairs Medical Center, Bronx, New York§The Health Literacy and Learning Program, Division of General Internal Medicine, Northwestern University, Chicago, Illinois; and #Division of General Internal Medicine, University of Texas, Southwestern, Dallas, Texas.
    Search for more papers by this author
  • Albert L. Siu MD, MSPH,

    1. From the *Division of General Internal Medicine, Department of Psychiatry, Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New YorkGeriatric Research, Education, and Clinical Center, Bronx Veterans Affairs Medical Center, Bronx, New York§The Health Literacy and Learning Program, Division of General Internal Medicine, Northwestern University, Chicago, Illinois; and #Division of General Internal Medicine, University of Texas, Southwestern, Dallas, Texas.
    Search for more papers by this author
  • Ethan A. Halm MD, MPH

    1. From the *Division of General Internal Medicine, Department of Psychiatry, Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New YorkGeriatric Research, Education, and Clinical Center, Bronx Veterans Affairs Medical Center, Bronx, New York§The Health Literacy and Learning Program, Division of General Internal Medicine, Northwestern University, Chicago, Illinois; and #Division of General Internal Medicine, University of Texas, Southwestern, Dallas, Texas.
    Search for more papers by this author

Address correspondence to Alex D. Federman, Division of General Internal Medicine, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, Box 1087, New York, NY 10029. E-mail: alex.federman@mssm.edu

Abstract

OBJECTIVES: To study the relationship between health literacy and memory and verbal fluency in older adults.

DESIGN: Cross-sectional cohort.

SETTING: Twenty senior centers and apartment buildings in New York, New York.

PARTICIPANTS: Independently living, English- and Spanish-speaking adults aged 60 and older (N=414).

MEASUREMENTS: Health literacy was measured using the Short Test of Functional Health Literacy in Adults (S-TOFHLA). The associations between S-TOFHLA scores and immediate and delayed recall (Wechsler Memory Scale II), verbal fluency (Animal Naming), and global cognitive function (Mini-Mental State Examination, MMSE) were modeled using multivariable logistic and linear regression.

RESULTS: Health literacy was inadequate in 24.3% of participants. Impairment of immediate recall occurred in 20.4%; delayed recall, 15.0%; verbal fluency, 9.9%; and MMSE, 17.4%. Abnormal cognitive function was strongly associated with inadequate health literacy: immediate recall (adjusted odds ratio (AOR)=3.44, 95% confidence interval (CI)=1.71–6.94, P<.001), delayed recall (AOR=3.48, 95% CI=1.58–7.67, P=.002), and verbal fluency (AOR=3.47, 95% CI=1.44–8.38, P=.006). These associations persisted in subgroups that excluded individuals with normal age-adjusted MMSE scores.

CONCLUSION: Memory and verbal fluency are strongly associated with health literacy, independently of education and health status, even in those with subtle cognitive dysfunction. Reducing the cognitive burden of health information might mitigate the detrimental effects of limited health literacy in older adults. Research that examines the effect of materials modified to older adults' cognitive limitations on health literacy and health outcomes is needed.

Get access to the full text of this article

Ancillary