Abstract
Background
Low health literacy and low cognitive abilities both predict mortality, but no study has jointly examined these relationships.
Methods
We conducted a prospective cohort study of 3,260 community-dwelling adults age 65 and older. Participants were interviewed in 1997 and administered the Short Test of Functional Health Literacy in Adults and the Mini Mental Status Examination. Mortality was determined using the National Death Index through 2003.
Measurements and Main Results
In multivariate models with only literacy (not cognition), the adjusted hazard ratio was 1.50 (95% confidence of interval [CI] 1.24–1.81) for inadequate versus adequate literacy. In multivariate models without literacy, delayed recall of 3 items and the ability to serial subtract numbers were associated with higher mortality (e.g., adjusted hazard ratios [AHR] 1.74 [95% CI 1.30–2.34] for recall of zero versus 3 items, and 1.32 [95% CI 1.09–1.60] for 0–2 vs 5 correct subtractions). In multivariate analysis with both literacy and cognition, the AHRs for the cognition items were similar, but the AHR for inadequate literacy decreased to 1.27 (95% CI 1.03 – 1.57).
Conclusions
Both health literacy and cognitive abilities independently predict mortality. Interventions to improve patient knowledge and self-management skills should consider both the reading level and cognitive demands of the materials.
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Acknowledgments
This work was supported by grant number R01 AB026393-01 from the National Institute on Aging. Dr. Wolf received support from a Centers for Disease Control and Prevention Career Development Award (K01 EH000067-01).
Contributions of Authors
We declare that we participated in the following:
Obtaining funding—Baker, Feinglass, Wolf; obtaining data and determining deaths from the National Death Index—Feinglass, Baker; analysis of the data and interpretation of the results—Baker, Wolf, Feinglass, Thompson; drafting of the manuscripts—Baker, Wolf, Feinglass; critical feedback and suggested revisions—Thompson.
Conflict of Interest
None disclosed.
Role of the Funding Source
The funding source (the National Institute on Aging) for this project played no role in the project.
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Baker, D.W., Wolf, M.S., Feinglass, J. et al. Health Literacy, Cognitive Abilities, and Mortality Among Elderly Persons. J GEN INTERN MED 23, 723–726 (2008). https://doi.org/10.1007/s11606-008-0566-4
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DOI: https://doi.org/10.1007/s11606-008-0566-4