1. Health Literacy in Older Adults Amanda Soong, MD Assistant Professor of Pediatrics Kathryn Hines, MD PGY-2 University of Alabama School of Medicine

2. Objectives  What is health literacy?  Health Literacy in Older Adults  Why is this topic important for pediatricians?  Decreased health literacy in older adults  What you can do as a pediatrician.

3. What is Health Literacy?  Health literacy includes the ability to understand and use health information to make decisions regarding one’s health.  More than the ability to read and write.  Includes  Listening  Following directions  Filling out forms and paperwork  Interacting with health care professionals  Make sense of medical terms  Understanding cultural norms

4. What affects health literacy?  Basic reading and writing skills  Ability to understand basic math  Communication skills of consumer/patient  Communication skills of healthcare professional  Situations one has faced in medical system  Decision making

5. Health Literacy in Older Adults  2003 National Assessment of Adult Literacy (NAAL)  Age group 65+ had the smallest proportion of people with proficient health literacy skills.  Age group 65+ had highest proportion of people with “below basic” health literacy.  71% of adults age 60+ had difficulty understanding facts written in prose  80% of adults age 60+ had difficulty understanding charts  68% of adults age 60+ had difficulty understanding quantitative tasks.  Older adults with access to resources and education level greater than high school had stronger literacy skills than adults of any age with any level of education living in poverty.

6. Health Literacy in Older Adults

7. Why does it matter to me?  Low health literacy is associated with worse health outcomes.  According to the American Community Survey in 2011,  There were 2,870,639 Grandparents who were Primary Caregivers to the grandchildren in their care.  1/3 of the Grandparent Caregivers were over the age of 60.  21.7% of Grandparent Caregivers, for whom income was known, live below the poverty level.

8. Why Does this Matter to Me?  Since more and more of our patients are cared for by grandparents, we need to be cognizant of the health literacy concerns for this population.  Even if a child is not in the custody of their grandparents, grandparents often play a significant role in their grandchild’s day to day care.  Many of these techniques would be helpful when dealing with any patient/family, not only grandparents.

9. Issues Affecting the Health Literacy of Older Adults  Vision Impairments  Hearing Impairment  Cognitive Challenges  Trends toward E-health tools

10. Vision Impairments  Estimated 14 million persons in U.S. have low vision, when defined as “visual problems that hamper the performance and enjoyment of everyday activities.”  Affects a person’s ability to fill out medical forms, understand health literature, properly use medications, and poses many safety risks.

11. Addressing Vision Impairments  Provide effective, “easy to see,” printed materials  Use sharp contrast between text and background  Use font size 16-18, Arial is preferable  1-inch margins  Make tables easy to follow  Braille or audiotape if necessary and available  Ask how you can help

12. Hearing Impairments  Hearing loss affects 1 in 3 adults over the age of 60, and half of adults over the age 85.  Age-related hearing loss is gradual, and typically the same in both ears.

13. Addressing Hearing Impairments  Limit background noise (TV, pagers, etc.)  Speak slowly and clearly, but do not shout. Try to lower the pitch of your voice if you are female.  Seat yourself across from the adult and maintain eye contact.  Make sure the light is in front of you, shining on your face.  Rephrase sentences into shorter statements if necessary.  Have them repeat back instructions.

14. Cognitive Challenges  Includes decreased processing speed, decreased working memory, and a greater tendency to be distracted.  Retaining lists of information, or step-by-step instructions, are particularly difficult.  Messages are easily remembered incorrectly.  These changes are different from cognitive impairment.

15. Addressing Cognitive Challenges  Repeat information as needed.  Make sure step-by-step instructions are understood correctly.  Focus on important details.  Personalize the information when possible.  Use the positive sense (“You should do this” not “You should not do that”)  Spend adequate time giving instruction.

16. E-Health Tools  “Digital resources designed to help patients, consumers, and caregivers find health information, store and manage their personal health information, make decisions, and manage their health.”  Use is increasing.  Effectiveness is low for older adults, who have greater need for these tools.  Also, be aware that some of our patients may not have reliable access to the internet.

17. Presenting Information: Using Plain Language  Address separate audiences separately.  Present the most important information at the beginning and end.  Organize information into “chunks.”  Use an active voice  Use “must” to convey requirements.  Write in short sentences and short paragraphs.  If a difficult word must be used, explain it.

18. Presenting Information: Additional Tips  Talk about important topics. Older adults respond better to face-to-face communication, as opposed to being given literature to read on their own.  Highlight short-term benefits of following specific recommendations.  Follow-up!

19. Conclusions  Older adults have lowest health literacy skills, as compared to other adult age groups.  Various issues impact health literacy of older adults  Vision impairments  Hearing impairments  Cognitive Challenges  “Disconnect” from E-health tools  There are many things we can do to address these issues and thus improve the care of our pediatric patients.

20. Conclusions: Effective Communication Checklist  Minimize noise and distractions  Sit at eye level, across from older adult  Speak slowly and clearly  Focus on important details  Give instructions in the positive sense  Personalize the information  Highlight short-term benefits  Have older adult repeat back step-by-step instructions  Repeat instructions as necessary  Provide “easy to see” materials  Use plain language  Ask how you can help  Follow Up

21. Sources  Quick Guide to Health Literacy and Older Adults. U.S. Department of Health and Human Services. www.health.gov/communication/literacy/olderadults/literacy.htm www.health.gov/communication/literacy/olderadults/literacy.htm  Quick Guide to Health Literacy. U.S. Department of Health and Human Services. www.health.gov/communication/literacy/quickguide/www.health.gov/communication/literacy/quickguide/  Centers for Disease Control and Prevention. Improving Health Literacy for Older Adults: Expert Panel Report 2009. Atlanta: U.S. Department of Health and Human Services; 2009.  Plain Language: A Strategic Response to the Health Literacy Challenge. Journal of Public Health Policy 2007, 28, 71-93  Sege, Robert D. et al. Anticipatory Guidance and Violence Prevention: Results from Family and Pediatrician Focus Groups. Pediatrics Feb 2006, 117, 2, 455-463  Benjamin, John T. et al. The office visit: A time to promote health – but how? Contemporary Pediatrics Feb 2002, 19, 2, 90-106

22. Sources  Improving Communication from the Federal Government to the Public. www.Plainlanguage.gov www.Plainlanguage.gov  Grandfacts: A State Fact Sheet for Grandparents and Other Relatives Raising Children. AARP. Alabama, August 2007  Hearing Loss and Older Adults. National Institute on Deafness and Other Communication Disorders. National Institute of Health. January 2001. www.nidcd.nih.gov/health/hearing/older.html www.nidcd.nih.gov/health/hearing/older.html  Presbycusis. National Institute on Deafness and Other Communication Disorders. National Institute of Health, October 1997. www.nidcd.nih.gov/health/hearing/presbycusis.html www.nidcd.nih.gov/health/hearing/presbycusis.html  U.S. Department of Health and Human Services. Healthy People 2010. 2001, 2, 28: Vision and Hearing. Washington, DC: U.S. Government Printing Office.