Intended for healthcare professionals

Rapid response to:


Health literacy: towards system level solutions

BMJ 2015; 350 doi: (Published 24 February 2015) Cite this as: BMJ 2015;350:h1026

Rapid Response:

The importance of health literacy at system level: Nations with higher proportion of low health literacy may experience the effects of aging more rapidly.

Several cross-sectional studies have been conducted in different countries with different tools and shown that age negatively associated with health literacy,1, 2 in which people getting older, their health literacy level getting lower. This could be explained by the age-related cognitive declines.3, 4 Indeed, there should be the other way around that health literacy effect to aging progress among older adults?
The impact of health literacy on aging progress could be explained via relation to physical function. Evidences from cross-sectional observations revealed that people with inadequate or marginal health literacy had worse physical function such as experienced more difficulties with daily living and more limitations in physical activity.
Samuel G Smith and colleague conducted a longitudinal study about health literacy and physical decline among community-dwelling older American adults.5 They used different tools to measure health literacy including Newest Vital Sign, or NVS; Rapid Estimate of Adult Literacy in Medicine, or REALM; Test of Functional Health Literacy in Adults, or TOFHLA. Results revealed that people with low or marginal health literacy were more likely to report worse physical function at baseline. After controlled for participant characteristics, health behaviours, time since baseline interview and baseline physical function scores, low health literacy respondents were exhibited over 2.5 times more likely to experience clinically meaningful decline in physical function than those with adequate health literacy after two to five years of follow-up.
Authors discussed that people with limited and marginal health literacy were more likely to experience poorer physical function, and they may further experience the effects of aging more rapidly. Which means lower health literacy would enhance the ageing progress among elderly people. In turn, populations with higher proportion of low health literacy might suffer the rapid aging process and its burden.
Future researches required to explain this relationship in longitudinal design among different populations with different tools. This will provide convincing evidences to clinicians, policy makers, and governments to implement public health strategies for older adults with limited health literacy, which proportion is large around the world.
I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare
1. Sørensen K, Pelikan JM, Röthlin F, et al. Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). The European Journal of Public Health. 2015: ckv043.
2. Kobayashi LC, Wardle J, Wolf MS and von Wagner C. Aging and Functional Health Literacy: A Systematic Review and Meta-Analysis. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 2014: gbu161.
3. Kobayashi L, Wardle J, Wolf M and von Wagner C. Cognitive Function and Health Literacy Decline in a Cohort of Aging English Adults. Journal of general internal medicine. 2015: 1-7.
4. Kobayashi LC, Smith SG, O'Conor R, et al. The role of cognitive function in the relationship between age and health literacy: a cross-sectional analysis of older adults in Chicago, USA. BMJ open. 2015; 5: e007222.
5. Smith SG, O'Conor R, Curtis LM, et al. Low health literacy predicts decline in physical function among older adults: findings from the LitCog cohort study. Journal of Epidemiology and Community Health. 2015; 0: 1-7.

Competing interests: No competing interests

08 June 2015
Van Tuyen Duong
Scientific Researcher
Taipei Medical University
No 250, Wuxing Street, Taipei City, Taiwan, 110