Elderly/Long-Term Care

Depression, hearing impairment, and health literacy influence older adults' abilities to self-manage their care

The degree to which elderly patients with high blood pressure can effectively assist in their own care (activation) is influenced by a set of measurable factors, according to a new study. It found that elderly persons with hypertension were more likely to be activated to self-manage their conditions if they had higher self-ratings of their own health, higher degrees of health literacy, greater receipt of patient-centered care, shorter lengths of stay in long-term care (LTC), and lower levels of depression and hearing impairment. The researchers looked at the scores of 275 chronically ill patients on the Patient Activation Measure (PAM). Of this group, 57 percent scored in the two lowest PAM stages, with only 8 percent scoring in the highest PAM stage.

The researchers suggest that, to improve patient self-management, clinicians should seek to expand their repertoire (and intensity) of patient communications and education methods to meet the individual's limitations. This particularly includes better management of depression symptoms, addressing hearing impairment, and adapting approaches to the patient's level of health literacy. The researchers used data from patients who were part of a New York State Medicaid-managed LTC program. The participants also underwent an in-home survey by trained interviewers that administered the PAM, a patient assessment of chronic illness care, a health-related quality-of-life measure, a measure of health literacy, and a geriatric depression scale. The study was funded in part by the Agency for Healthcare Research and Quality (Contract No. 209-00-0013).

More details are in "Activation among chronically ill older patients with complex medical needs. Challenges to support effective self-management," by Linda M. Gerber, Ph.D., Yolanda Barrón, M.S., Jennifer Mongoven, M.P.H., and others in the July/September 2011 Journal of Ambulatory Care Management 34(3), pp. 292-303.

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