1. School of Nursing Health Literacy Among Informal Caregivers of Persons With Memory Loss Judith A. Erlen, PhD, RN, FAAN; Jennifer H. Lingler, PhD, RN; Lisa K. Tamres, MS; Kidane B. Ghebrehawariat, MS; and Susan M. Sereika, PhD University of Pittsburgh School of Nursing Supported by NIH NINR P01NR010949

2. School of Nursing Acknowledgements Supported by NIH NINR P01NR010949 Patients and their caregivers Research Staff Students Community Advisory Board Community liaisons

3. School of Nursing Background Caregivers of persons with memory loss face increasing challenges over time Medication management is one such issue Of concern is the caregivers’ level of understanding of medication management Assessing health literacy is important Research describing the relationship between health literacy and correct medication management is limited

4. School of Nursing Purpose To examine the relationships among selected demographic variables, medication taking deficiencies, and health literacy in a sample of family caregivers of persons with memory loss

5. School of Nursing Methods: Overall Study RCT designed to increase problem solving related to medication management –Recruited patients with memory loss and their informal caregivers from multiple community sites –Eligible dyads were randomized to intervention and control following baseline data collection –Intervention dyads were randomly assigned to either a nurse or a social worker –All interventions and data collections occurred in the home or via telephone

6. School of Nursing Methods: Current Study Descriptive study –Used baseline data Analysis: Descriptive statistics of caregiver and patient data –Spearman correlation coefficient to examine relationships

7. School of Nursing Variables of Interest Sociodemographic characteristics –Gender, age, race, education, relationship to patient Number of co-morbidities Health literacy –Newest Vital Sign (NVS) Medication errors –Medication Management Instrument for Deficiencies in the Elderly (MedMAIDE) –Medication Deficiency Checklist

8. School of Nursing Newest Vital Sign (NVS) (Weiss et al (2005), Annals of Family Medicine) A brief health literacy screening instrument –uses a nutrition label accompanied by 6 questions –assesses numeracy and comprehension. Administration time is about 3 minutes. NVS psychometrics: –Cronbach’s alpha=.76 –Correlates with the TOFHLA (r= 0.59, p<.001)

9. School of Nursing Medication Management Instrument for Deficiencies in the Elderly (MedMAIDE) (Orwig et al (2006), The Gerontologist) Brief assessment of medication taking behavior using observation and interview to examine potential issues of compliance and medication management in the home. Consists of 20 items addressing: –Knowledge of medications –Appropriate administration –Knowledge of how to obtain refills. Psychometrics: –Cronbach’s alpha=.71 –Test-retest: (intraclass correlation coefficient) ICC= 0.93. –Interrater reliability: ICC=0.74

10. School of Nursing Medication Deficiency Checklist Investigator developed Based on the literature, observations, and interview data List of possible errors related to medication preparation and administration –Response format: yes or no

11. School of Nursing Sample Characteristics Caregivers (n=76) Gender:Race: Males: 22 (28.95%)White: 66 (86.84%) Females: 54 (71.05%)Non-white: 10 (13.16%) Age: Mean = 67.38 yrs; Range = 42-93 yrs Education: Mean = 14.97 yrs; Range = 9-30 yrs Co-morbidities: Mean = 6.81; Range = 1-17 Relationship to patient: Spouse:45 (59.21%) Other:6 (7.91%) Child:25 (32.89%)

12. School of Nursing Gender:Race: Males: 31 (40.79%)White: 66 (86.84%) Females: 45 (59.21%)Non-white: 10 (13.16%) Age: Mean = 80.07 yrs; Range = 60-97 yrs Education: Mean = 13.45 yrs; Range = 3-22 yrs Co-morbidities: Mean = 8.53; Range = 1-20 Sample Characteristics Patients (n=76)

13. School of Nursing Summary Statistics: Instruments Newest Vital Sign –Mean = 4.08; Range = 0.00 - 6.00; SD = 1.81 MedMAIDE –Mean = 0.69; Range = 0.00 - 2.00; SD = 0.71 Medication Deficiency Checklist –Mean = 2.80; Range = 0.00 - 8.00; SD = 1.75

14. School of Nursing Associations Health Literacy –Age: -0.38 (p=.00) –Education: 0.38 (p=.00) –Med. Deficiencies: 0.20 (p=.10) Co-morbidities –Age: 0.23 (p=.05) –Med. Deficiencies: 0.27 (p=.02) All other associations were not statistically significant

15. School of Nursing Conclusions Caregivers with higher health literacy were younger and had more education. Fewer medication deficiencies were seen among older caregivers

16. School of Nursing Limitations Only baseline data Small sample size Limited diversity within the sample

17. School of Nursing Implications There is a need to assess health literacy and understanding of instructions Health care providers cannot assume that caregivers with adequate health literacy will be able to correctly follow instructions when managing medications of family members