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Health & Medicine for Senior Citizens

Low Health Literacy Associated With Higher Rate of Death Among Heart Failure Patients

Low health literacy patients were older, of lower socioeconomic status and less likely to have a high school education; also more likely to have multiple chronic diseases - watch video

April 26, 2011 – An examination of health literacy - such as understanding basic health information - among managed care patients with heart failure, a condition that requires self-management, found that nearly one in five have low health literacy, which was associated with a higher all-cause risk of death, according to a study in the April 27 issue of the Journal of the American Medical Association (JAMA).

Health literacy is the degree to which individuals can obtain, process and understand basic health information and services needed to make appropriate health decisions, as defined by the Institute of Medicine.

Many U.S. citizens and as many as 1 in 3 Medicare enrollees have low health literacy. Heart failure is a common and complex chronic disease with a high risk of illness and death, according to the article.


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"Although patients with heart failure are frequently hospitalized, much care for heart failure is performed on a daily basis by individual patients outside of the hospital," the authors write.

“This self-care requires integration and application of knowledge and skills. Therefore, an adequate level of health literacy is likely critical in ensuring patient compliance and proficiency in self-management. Little is known about the association between health literacy and outcomes among patients with heart failure."

Pamela N. Peterson, M.D., M.S.P.H., of the Denver Health Medical Center, Denver, and colleagues evaluated the association between low health literacy and all-cause mortality and hospitalization among a population of outpatients with heart failure.


Senior citizens (65+) scored far lower than younger people in a 2003 literacy test. The test had a maximum score of 500.


The study included patients of an integrated managed care organization with heart failure who were identified between January 2001 and May 2008. They were surveyed by mail and underwent follow-up for a median (midpoint) of 1.2 years.

Health literacy was assessed using three established screening questions and categorized as adequate or low. Responders were excluded if they did not complete at least 1 health literacy question or if they did not have at least 1 year of enrollment prior to the survey date.

Of the 2,156 patients surveyed, 1,547 responded (72 percent response rate). Of 1,494 included responders, 262 (17.5 percent) had low health literacy. Patients with low health literacy were older, of lower socioeconomic status, and less likely to have at least a high school education. They were also more likely to have coexisting illnesses such as diabetes, hypertension, chronic pulmonary disease, and stroke.

There were a total of 124 deaths during follow-up, with 46 deaths (17.6 percent) in the low health literacy group and 78 (6.3 percent) in the adequate health literacy group.

There were a total of 366 hospitalizations during follow-up, with 80 hospitalizations (30.5 percent) in the low health literacy group and 286 (23.2 percent) in the adequate health literacy group.

After adjusting for demographic variables, socioeconomic status, education, comorbid conditions, year of cohort entry, and left ventricular ejection fraction (a measure of how well the left ventricle of the heart pumps with each contraction), low health literacy was independently associated with an increased risk of mortality.



  Many Senior Citizens Risk Medical Errors Due to Low Health Literacy


Difficulty understanding 'medical speak' found in one-third of patients

Feb. 12, 2007 – To get well, you need to follow the doctor's orders. But, to follow the doctor's orders, you have to understand them. Senior citizens are the most likely not to understand medical instructions. Many other Americans, too, suffer from low health literacy, or difficulty understanding "medical speak." This is a problem affecting more than one-third of patients in the U.S. health care system. View this video to learn more. Click here to watch video.


In adjusted models, low health literacy was not significantly associated with all-cause hospitalization.

The authors suggest that routine assessment of health literacy may help to identify a greater number of patients at risk for adverse outcomes.

"In conclusion, this study demonstrates that even among those with health insurance and access to health information, low health literacy as assessed by 3 brief screening questions is associated with higher mortality. This finding supports efforts to determine whether interventions to screen for and address low health literacy can improve important health outcomes in patients with heart failure," the researchers conclude.

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