Correlates of health and financial literacy in older adults without dementia

BMC Geriatrics

David A Bennett³  Bryan D James²  Patricia A Boyle¹  Jarred S Bennett¹ 

[1]Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, USA

[2]Department of Internal Medicine, Rush University Medical Center, Chicago, USA

[3]Department of Neurological Sciences, Rush University Medical Center, Chicago, USA

关键词: Dementia;    Older adults;    Financial literacy;    Health literacy;   

Others  :  858106
DOI  :  10.1186/1471-2318-12-30

 received in 2011-11-06, accepted in 2012-05-31,  发布年份 2012

【 摘 要 】

Background

Recent research has begun to recognize the important influence of literacy levels and how they affect health and wellbeing, especially in older adults. Our study focuses on health and financial literacy, two domains of literacy which previous research has suggested may be significantly related to health and wellbeing. Our study examines the relation of health and financial literacy with health promoting behaviors and health status among community-based older persons.

Methods

We conducted a cross-sectional study using data from the Rush Memory and Aging Project, a community-based cohort study of aging in northeastern Illinois. The study consisted of 556 older persons without dementia, each determined by a clinical evaluation. Health and financial literacy were measured using a series of questions designed to assess the ability to understand and process health and financial information, concepts, and numeracy; the two scores were averaged to yield a total literacy score. Health promoting behaviors, including engagement in cognitive, physical, and social activities, were assessed using self report measures. Indicators of heath status, including cognition (global cognition and five specific cognitive abilities), functional status (basic and instrumental activities of daily living, mobility disability), and mental health (depressive symptoms, loneliness) were assessed.

Results

In a series of regression models adjusted for age, sex, and education, higher total literacy scores were associated with more frequent participation in health promoting behaviors, including cognitive, physical and social activities (all p values <0.05). Higher total literacy scores were associated with higher cognitive function, less disability, and better mental health (all p values < 0.05). Literacy remained associated with health promoting behaviors and health status in fully adjusted models that also controlled for income and the number of chronic medical conditions. Most of the findings were similar for health and financial literacy except that health literacy was more strongly associated with health promoting behaviors whereas financial literacy was more strongly associated with mental health.

Conclusions

Health and financial literacy are associated with more frequent engagement in health promoting behaviors and better health status in older persons without dementia.

【 授权许可】

   
2012 Bennett et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]UNESCO Education Sector: Position Paper:The Plurality of Literacy and its Implications for Policies and Programmes. UNESCO, Paris; 2004.
• [2]Kutner M, Greenberg E, Jin Y, Boyle B, Hsu Y, Dunleavy E: Literacy in everyday life: Results from the 2003 National Assessment of Adult Literacy. U.S. Department of Education, National Center for Education Statistics, Washington DC; 2007. (NCES 2007–480). http://eric.ed.gov/PDFS/ED495996.pdf webcite
• [3]Baker DW, Parker RM, Williams MV, Clark WS, Nurss J: The relationship of patient reading ability to self-reported health and use of health services. Am J Public Health 1997, 87:1027-1030.
• [4]Sudore RL, Mehta KM, Simonsick EM, Harris TB, Newman AB, Satterfield S, Rosano C, Rooks RN, Rubin SM, Ayonayon HN, Yaffe K: Limited literacy in older people and disparities in health and healthcare access. J Am Geriatr Soc 2006, 54:770-776.
• [5]Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, Palacios J, Sullivan GD, Bindman AB: Association of health literacy with diabetes outcomes. J Am Med Assoc 2002, 288:475-482.
• [6]Baker DW, Wolf MS, Feinglass J, Thompson JA, Gazmararian JA, Huang J: Health literacy and mortality among elderly persons. Arch Intern Med 2007, 167:1503-1509.
• [7]Howard DH, Gazmararian J, Parker RM: The impact of low health literacy on the medical costs of Medicare managed care enrollees. Am J Med 2005, 118:371-377.
• [8]Scott TL, Gazmararian JA, Williams MV, Baker DW: Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Med Care 2002, 40:395-404.
• [9]Gazmararian JA, Williams MV, Peel J, Baker DW: Health literacy and knowledge of chronic disease. Patient Educ Couns 2003, 51:267-275.
• [10]Christelis D, Jappelli T, Padula M: Cognitive abilities and portfolio choice. University of Salerno,  ; 2006. CSEF Working Paper No. 157
• [11]Parker RM: Health literacy: a challenge for american patients and their health care providers. Health Promot Int 2006, 15:277-291.
• [12]Federman AD, Sano M, Wolf MS, Siu AL, Halm EA: Health Literacy and Cognitive Performance in Older Adults. J Am Geriatr Soc 2009, 57:1475-1480.
• [13]Wolf MS, Gazmararian JA, Baker DW: Health literacy and functional health status among older adults. Arch Intern Med 2005, 165(17):1946-1952.
• [14]McArdle J, Smith JP, Willis R: Cognition and economic outcomes in the Health and Retirement Survey. Forthcoming in New Directions in the Economics of Aging. University of Chicago Press,  ; 2009. NBER Working Paper 15266
• [15]Saha S: Improving literacy as a means to reducing health disparities. J Gen Intern Med 2006, 21:8936-8945.
• [16]Shrestha Laura B: The changing demographic profile of the United States. Congressional Research Service Report. Congressional Research Service, Washington DC; 2006.
• [17]Hobbs FB: The Elderly Population.  ,  ; 1999. Http://www.census/population/www/pop-profile/elderpop html webcite
• [18]James BD, Boyle PA, Bennett JS, Bennett DA: The impact of health and financial literacy on decision making in community-based older adults. Gerontology 2012,  : . In press
• [19]Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs AMA: Health literacy. JAMA 1999, 281:552-557.
• [20]Institute of Medicine: Health literacy: A prescription to end confusion. National Academies Press, Washington, DC; 2004.
• [21]Lusardi A, Mitchell OS, Baby boomer retirement security: The roles of planning, financial literacy, and housing wealth. J Monet Econ 2007, 54:205-224.
• [22]Lusardi A, Mitchell OS: Financial Literacy and Planning: Implications for Well-Being. Pension Research Council 2006.,  working paper WP2006-01
• [23]Taylor M: Jenkins S. Financial Capability and wellbeing. Evidence from the BHPS. Financial Services Authority, Sacker A; 2009.
• [24]Bennett DA, Schneider JA, Buchman AS, Mendes de Leon C, Bienias JL, Wilson RS: The Rush Memory and Aging Project: study design and baseline characteristics of the study cohort. Neuroepidemiology 2005, 25:163-175.
• [25]McKhann G, Drachman D, Folstein MF, Katzman R, Price D, Stadlan EM: Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA-work group under the auspices of department of health and human services, task force on Alzheimer's disease. Neurology 1984, 34:939-944.
• [26]Juster T, Suzman R: An Overview of the Health and Retirement Study. J Hum Resour 1995, 30:S7-S56.
• [27]Wilson RS, Barnes LL, Bennett DA: Assessment of lifetime participation in cognitively stimulating activities. J Clin Exp Neuropsychol 2003, 25:634-642.
• [28]Wilson RS, Barnes LL, Krueger KR, Hoganson G, Bienias JL, Bennett DA: Early and late life cognitive activity and cognitive systems in old age. J Int Neuropsychol Soc 2005, 11:400-407.
• [29]Wilson RS, Scherr PA, Schneider JA, Tang Y, Bennett DA: Relation of cognitive activity to risk of developing Alzheimer disease. Neurology 2007, 69:1911-1920.
• [30]McPhillips JB, Pellettera KM, Barrett-Connor E, Wingard DL, Criqui MH: Exercise patterns in a population of older adults. Am J Prev Med 1989, 5:65-72.
• [31]Buchman AS, Boyle PA, Wilson RS, Bienias JL, Bennett DA: Physical activity and motor decline in older persons. Muscle Nerve 2007, 35:354-362.
• [32]Boyle PA, Buchman AS, Wilson RS, Bienias JL, Bennett DA: Physical activity is associated with incident disability in community-based older persons. J Am Geriatr Soc 2007, 55:195-201.
• [33]Krueger KR, Wilson RS, Kamenetsky JM, Barnes LL, Bienias JL, Bennett DA: Social engagement and cognitive function in old age. Exp Aging Res 2009, 35:45-60.
• [34]Buchman AS, Boyle PA, Wilson RS, Fleischman DA, Leurgans S, Bennett DA: Association between late-life social activity and motor decline in older adults. Arch Intern Med 2009, 169:1139-1146.
• [35]de Leon CF Mendes, Glass TA, Berkman LF: Social engagement and disability in a community population of older adults. Am J Epidemiol 2003, 157:633-642.
• [36]James BD, Boyle PA, Buchman AS, Bennett DA: Relation of late-life social activity with incident disability among community-dwelling older adults. The Journals of Gerontology 2011, 66:467-473.
• [37]James BD, Wilson RS, Barnes LL, Bennett DA: Late-Life Social Activity and Cognitive Decline in Old Age. J Int Neuropsychol Soc 2011, 12:189-198. In Press. Publication
• [38]Folstein MF, Folstein SE, McHugh PR: "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatrich Research 1975, 12:189-198.
• [39]Kohout FJ, Berkman LF, Evans DA, Cornoni-Huntley J: Two shorter forms of the CES-D (Center for Epidemiological Studies of Depression) depression symptoms index. J Aging Health 1993, 5:179-193.
• [40]Bennett DA, Wilson RS, Schneider JA, Bienias JL, Arnold SE: Cerebral infarctions and the relationship of depressive symptoms to level of cognitive functioning in older persons. Am J Geriatr Psychiatry 2004, 12:211-219.
• [41]de Jong-Gierveld J: Developing and testing a model of loneliness. J Pers Soc Psychol 1987, 53:119-128.
• [42]Wilson RS, Krueger KR, Arnold SE, Schneider JA, Kelly JF, Barnes LL, Tang Y, Bennett DA: Loneliness and risk of Alzheimer’s disease. Arch Gen Psychiatry 2007, 64:234-240.
• [43]Boyle PA, Buchman AS, Barnes LL, Bennett DA: Effect of a Purpose in Life on Risk of Incident Alzheimer Disease and Mild Cognitive Impairment in Community- Dwelling Older Persons. Arch Gen Psychiatry 2010, 67:304-310.
• [44]Cary NC:  . ,  : . SAS Institute Inc.; 2009 SAS 9.2 Help and Documentation [computer program]
• [45]Gazmararian J, Baker D, Parker R, Blazer DG: A multivariate analysis of factors associated with depression: evaluating the role of health literacy as a potential contributor. Arch Intern Med 2000, 160:3307-3314.
• [46]Currie J, Tekin E: Is the Foreclosure Crisis Making Us Sick? The National Bureau of Economic Research 2011,  : . NBER Working Paper No. 17130
• [47]Hadjimatheou C: Confronting suicide as Greek social problems mount.    ,  : . http://www.bbc.co.uk/news/world-europe-15334586 webcite
• [48]Widera E, Steenpass V, Marson D, Sudore R: Finances in the older patient with CI: “He didn’t want me to take over. J Am Med Assoc 2011, 305:698-706.
• [49]Sela-Katz P, Rabinowitz I, Shugaev I, Shigorina G: Basic knowledge of the medication regimen correlates with performance on cognitive function tests and diagnosis of dementia in elderly patients referred to a geriatric assessment unit. Gerontology 2010, 56:491-495.
• [50]Lyons AC: Credit practices and financial education needs of Midwest College Students. A report to Midwest College Administrators. University of Illinois at Urbana-Champaign,  ; 2003. http://www.cefe.illinois.edu/research/reports/Credit%20Practices%20and%20Fin%20Educ%20Needs%20of%20Midwest%20College%20Students_122003.pdf webcite
• [51]Foresight Mental Capital and Wellbeing Project: Final project report – Executive summary. The Government Office for Science, London; 2008.
• [52]Kuh D, Ben-Shlomo Y, Lynch J, Hallqvist J, Power C: Life course epidemiology. J Epidemiology Community Health 2003, 57:778-783.
• [53]Davis T, Crouch M, Long S, et al.: Rapid assessment of literacy levels of adult primary care patients. Fam Med 1991, 23:433-435.
• [54]Parker RM, Baker DW, Williams MV, Nurss JR: The test of functional health literacy in adults: a new instrument for measuring patient's literacy skills. J Gen Intern Med 1995, 10:537-541.