Older people with poorer reading skills have higher mortality risk

Approximately one third of older individuals with poor literacy skills appear to have a higher chance of dying over a five-year period, compared to others of the same age, researchers from University College, London, reported in the BMJ (British Medical Journal) today. Poor literacy skills means the person has trouble reading and understanding straightforward health information. As the British government is pushing for greater responsibility by patients and their active partners regarding their care, the authors say their findings have major implications on how health care services are designed and delivered. "Health literacy" measures a person's reading skills and basic knowledge in a health-related context. Poor reading skills in this context is linked to less knowledge of chronic illnesses, poorer physical and mental health, less use of preventive services compared to others of the same age, and higher hospitalization rates. Research associate, Sophie Bostock, UCL Epidemiology & Public Health, and Professor Andrew Steptoe set out to determine what the relationship between health literacy and mortality might be among older individuals in England, regardless of factors such as pre-existing illness, age, and socioeconomic level. They gathered data from the ELSA (English Longitudinal Study of Ageing), which included 7,857 people aged 52 years. Those being studied had participated in the second wave of the study, during 2005-2005. They were all assessed for functional health literacy - researchers determined their level of comprehension regarding written instructions related to what to do when taking an aspirin tablet. The authors monitored deaths up to October 2009. About one third of participants could not understand the label instructions fully - meaning their health literacy was limited. During the follow-up period, 6% (321) in the high test score group died, compared to 9% (143) among those in the medium-score group, and 16% (157) in the low-score group. The lowest scorers were found to have double the risk of dying within five years compared to the highest scorers. Less than half of the increased risk of death was attributed to other factors, such as age differences, general health when the study began, and socioeconomic position. The authors stressed that poor health literacy remained a "significant predictor of mortality", even after making adjustments for measures of cognitive function. If the sample population studied is nationally representative, about one third of older English adults have poor health literacy, and those with the poorest literacy levels have the highest risk of death. Bostock said: "This study is a reminder that providing information doesn't necessarily equate to understanding. The patients most vulnerable to adverse health outcomes are those least likely to understand written health information. The findings should remind all healthcare professionals to adopt effective communication techniques for patients with low health literacy. The design and delivery of health related services for older adults in England should be sensitive to the limited health literacy capabilities within this population." In an Abstract in the same journal, the authors concluded: "The limited health literacy capabilities within this population have implications for the design and delivery of health related services for older adults in England."