Who is this guide for?

The Quick Guide to Health Literacy and Older Adults is for people who serve older adults on health and aging issues. The guide provides background information on health literacy and strategies and suggestions for communicating with older adults. Links to many helpful resource materials are included for you to investigate specific topics in greater detail. This guide builds on the information presented in the Quick Guide to Health Literacy, published by the U.S. Department of Health and Human Services.

Why are the health literacy needs of older adults important?

Problems with health literacy affect millions of Americans, including older adults. More than 77 million U.S. adults have basic or below basic health literacy skills.¹ For the growing population of older Americans aged 65 years or older—expected to reach more than 71 million by 2030²—difficulties with health literacy can complicate already challenging health problems.

What is health literacy?

Health literacy has to do with how well people understand and are able to use health information to take action on their health. More than just the ability to read and write, health literacy includes the ability to listen, follow directions, fill out forms, calculate using basic math, and interact with professionals and health care settings. It can also include making sense of jargon or unfamiliar cultural norms. Health literacy requires people to apply critical thinking skills to health-related matters.^3,4

Health literacy has been defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions."⁵ A person's health literacy is influenced by a number of factors, including basic literacy skills, the communication skills of health professionals, and the situations one encounters in the health care system.⁶ These issues affect how a person finds a doctor, reads instructions for medicine, or takes other health-related action.⁶ Also, to take such action people often need a realistic understanding of health and disease. People with low health literacy skills often lack such knowledge.⁶

Anyone can have low health literacy, including people with good literacy skills. In fact, most people will have trouble understanding health information at some point in their lives. For example, people experiencing serious health problems may come across specific medical terms or health information for the first time.⁴

As you work to improve the health of older adults, you need to be aware of their health literacy needs. Here's why:

• Health outcomes are related to health literacy. Studies have shown that patients with low health literacy have trouble understanding health information and getting preventative health care. These patients may use emergency rooms and other expensive health services more often than patients with higher health literacy skills.⁴
• As many as 80 percent of older Americans have at least one chronic health condition.⁷ The more health conditions people have, the more they need to navigate the health care system and interpret complex health information. These tasks are challenging for people with low health literacy. Particular challenges for some older adults are accessing health information on the Internet and using basic math.⁸
• Literacy problems will not always be obvious to you. Some people hide their problem out of shame, or they may not recognize the difficulty they have with reading. Such individuals may not ask important health questions, or they may misunderstand a health care provider's directions.⁹

Resource

The Quick Guide to Health Literacy includes a basic overview of health literacy, techniques for improving health literacy, and examples of health literacy best practices. This resource may be especially helpful to people who are looking for assistance on a range of health literacy issues. The guide can be found at www.health.gov/communication/literacy/quickguide.

What special issues apply to older adults?

The following sections address health conditions that can impact older adults' health literacy. Highlights of effective strategies and suggestions for you to consider when communicating and working with older adults are included. Adjusting the way you communicate may help older adults increase health literacy skills.

Note: Be sensitive to cultural, language, and other differences among the older adults you serve. Some suggestions in this guide may not be appropriate for everyone.

Endnotes

1. Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of America's Adults: Results From the 2003 National Assessment of Adult Literacy (NCES–483). U.S. Department of Education. Washington, DC: National Center for Education Statistics; 2006.
2. U.S. Administration on Aging. Statistics on the Aging Population. Available at www.aoa.gov. Accessed July 2007.
3. National Library of Medicine. Health Literacy. Available at http://nnlm.gov/outreach/consumer/hlthlit.html. Accessed July 2007. 
4. Institute of Medicine. Health Literacy: A Prescription to End Confusion. Washington, DC: National Academies Press; 2004.
5. U.S. Department of Health and Human Services. Healthy People 2010. Washington, DC: U.S. Government Printing Office. 2000. Originally developed for Ratzan SC, Parker RM. Introduction. In National Library of Medicine Current Bibliographies in Medicine: Health Literacy. Selden CR, Zorn M, Ratzan SC, Parker RM, Editors. NLM Pub. No. CBM 2000–1. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services; 2000.
6. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Quick Guide to Health Literacy. Available at www.health.gov/communication/literacy/quickguide. Accessed July 2007.
7. Centers for Disease Control and Prevention and the Merck Company Foundation. The State of Aging and Health in America 2007: Executive Summary. Whitehouse Station, NJ: The Merck Foundation; 2007.
8. Information included here with the expert guidance of Elias JW, University of California, Davis.
9. Parker R. Health literacy: a challenge for American patients and their health care providers. Health Promotion International. Oxford University Press. 2002;14(4):277–283.