NEW YORK NURSE: October 2011
by Elizabeth Woytowicz, MS, RN, Faculty, St. Joseph’s College of Nursing & Gina Myers, PhD, RN, Assistant Professor, Le Moyne College, Syracuse, Foundation of New York State Nurses Center for Nursing Research Planning Committee
Do your elderly patients really understand the information they receive to make informed decisions about their health and manage their care? It may surprise you to know the answer is “no” even though the majority of your patients will tell you “yes.”
The reason elderly patients may not understand healthcare information is due to limited health literacy. Health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health” (Institute of Medicine, 2004). The elderly will comprise 20 percent of the U.S. population by 2030 (Administration on Aging, 2008) and many will have a chronic disease such as hypertension, diabetes, or heart failure. It is essential that you take the time to assess your patients’ true knowledge of their disease and comprehension of their treatment plan to help ensure success with compliance. To do this successfully, nurses must become educated about health literacy and effective teaching methods for use with the elderly population.
To understand its impact on the elderly, Cutilli (2007) completed an integrative review focused on health literacy and the geriatric patient population. In this type of review, the author examines a variety of study results and incorporates their findings to explain the current knowledge on the topic (Burns & Grove, 2011). In addition, Baker, Wolf, Feinglass, and Thompson (2008) performed a study on adults over 65 to determine the relationship between health literacy, cognitive abilities and mortality.
Cutilli (2007) reviewed 20 research articles with sample sizes ranging from 20 to 3,000 individuals who had taken a health literacy test. Test results indicated a link between patients’ health literacy levels and their age, education, and income, with advanced age, lower income, and less education found to be indicators of low health literacy. Furthermore, low health literacy was associated with lower health status, less medication compliance, and reduced knowledge of disease.
When reviewing medication compliance, studies were performed to determine what methods of patient education increased knowledge and compliance. Older adults’ knowledge and medication compliance improved when verbal, written, and visual instructions were patient-specific. In regards to managing self-care of chronic diseases, DeWalt et al., (2004) studied the impact of a disease management program developed for patients with heart failure and low health literacy. The results showed that compliance with the treatment regimen was improved with exposure to videos or teaching sessions, followed by subsequent review with patients. Follow up phone calls allowed for further assessment of patients’ true knowledge and abilities for managing their diseases at home successfully, while providing reinforcement and support for patients and families (DeWalt et al., 2004).
Patients with both limited health literacy and decreased cognitive ability also have an increased likelihood of hospitalization and decreased attention to preventative health. Baker et al. (2008) discovered that limited health literacy and decreased cognitive abilities both impact mortality, as these patients may not be able to read directions effectively or remember verbal instructions.
Effective health communication between patients and nurses is essential to successful self-management. Therefore, an array of educational tools that simplify the message must be used to improve health literacy.
Baker et al. (2008) stress that tools such as plain language (free of difficult medical terminology) and teach back strategies (teaching content repeatedly until patients can verbalize in their own words the prescribed treatment plan) assist with addressing the cognitive deficits and literacy problems of patients. Cutilli (2007) reinforces that pictures, charts and directions at the correct reading level will also improve compliance.
With the increasing complexity of health care, it is more important than ever to assess patients for gaps in health literacy and cognitive abilities. As the nurse, you may be the first and last person to interact with patients and families during a hospitalization or office visit. Therefore, you can improve patient outcomes by taking the time to discover what methods of education best serve their needs based on health literacy and cognitive levels.
Administration on Aging (2008). Aging Statistics. Retrieved from Administration on Aging website: www.aoa.gov/AoARoot/Aging_Statistics/index.aspx
Baker, D. W., Wolf, M. S., Feinglass, J., & Thompson, J. A. (2008). Health literacy, cognitive abilities, and mortality among elderly persons. Journal of General Internal Medicine, 23(6), 723-726. doi: 10.1007/s11606-008-0566-4
Burns, N., & Grove, S. K. (2011). Understanding the literature review in published studies. In M. Iannuzzi (Ed.), Understanding nursing research: Building an evidenced-based practice (5th ed.). (pp. 220). Maryland Heights, MO: Elsevier Saunders.
Cutilli, C. C. (2007). Health literacy in geriatric patients: An integrative review of the literature. E-Journal of Orthopaedic Nursing, 26(1), 43-48. Retrieved from http://web.ebscohost.com.ezproxy.sunyit.edu/ehost/pdfviewer/pdfviewer?sid=29d9381f-f106-4045-bef5-faa0bfa80ab5%40sessionmgr4&vid=9&hid=15
DeWalt, D., Pignone, M., Malone, R., Rawls, C., Kosnar, M., George, G., ... Angel, B. (2004). Development and pilot testing of a disease management program for low literacy patients with heart failure. E-Journal of Patient Education & Counseling, 55(1), 78-86. Retrieved from www.sciencedirect.com.ezproxy.sunyit.edu/science/article/pii/S0738399103002544
Institute of Medicine. (2004). Report Brief on Health Literacy: A Prescription to End Confusion. Retrieved from Institute of Medicine website: http://iom.edu/~/media/Files/Report%20Files/2004/Health-Literacy-A-Prescription-to-End-Confusion/healthliteracyfinal.pdf