Health literacy and performance on the Mini-Mental State Examination.

The objectives of the study were to determine the relationship between functional health literacy and performance on the Mini-Mental State Examination (MMSE). New Medicare managed-care enrollees aged 65 years and older, living independently in the community in four US cities (Cleveland, Houston, Tampa, and Fort Lauderdale/Miami), were eligible to participate. In-home interviews were conducted to determine demographics and health status, and interviewers then administered the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the MMSE. We then determined the relationship between functional health literacy and the MMSE, including total scores, subscale scores (orientation to time, orientation to place, registration, attention and calculation, recall, language, and visual construction), and individual items. Functional health literacy was linearly related to the total MMSE score across the entire range of S-TOFHLA scores (R(2) = 0.39, p < 0.001). This relationship between health literacy and MMSE was consistent across all MMSE subscales and individual items. Adjustment for chronic conditions and self-reported overall health did not change the relationship between health literacy and MMSE score. Health literacy was related to MMSE performance even for subscales of the MMSE that were not postulated to be directly dependent on reading ability or education (e.g. delayed recall). These results suggest that the lower MMSE scores for patients with low health literacy are only partly due to 'test bias' and also result from true differences in cognitive functioning. 'Adjusting' MMSE scores for an individual's functional health literacy may be inappropriate because it may mask true differences in cognitive functioning.

Lack of health insurance and decline in overall health in late middle age.

BACKGROUND: The number of adults in their 50s and 60s in the United States who do not have health insurance is increasing. This group may be particularly vulnerable to the ill effects of being uninsured. METHODS: We conducted a prospective cohort study using files from the Health and Retirement Study, a national survey of adults who were 51 to 61 years old in 1992. We determined the risks of a major decline in overall health and of the development of new physical difficulties between 1992 and 1996 for participants who were continuously uninsured (uninsured in 1992 and in 1994), those who were intermittently uninsured (uninsured either in 1992 or in 1994), and those who were continuously insured. We used logistic regression to determine the independent effects of being uninsured on health outcomes after adjustment for base-line sociodemographic factors, preexisting medical conditions, and types of health-related behavior such as smoking and alcohol use. RESULTS: We analyzed data for 7577 participants. The 717 continuously uninsured participants and the 825 intermittently uninsured participants were more likely than the 6035 continuously insured participants to have a major decline in overall health between 1992 and 1996 (21.6 percent, 16.1 percent, and 8.3 percent of the three groups, respectively; P<0.001 for both comparisons). According to a multivariate analysis, the adjusted relative risk of a major decline in overall health was 1.63 (95 percent confidence interval, 1.26 to 2.08) for continuously uninsured participants and 1.41 (95 percent confidence interval, 1.11 to 1.78) for intermittently uninsured participants, as compared with continuously insured participants. A new difficulty in walking or climbing stairs was also more likely to develop in the continuously or intermittently uninsured participants than in the continuously insured participants (28.8 percent, 26.4 percent, and 17.1 percent of the three groups, respectively; P<0.001 for both comparisons). The adjusted relative risk of such a new physical difficulty was 1.23 (95 percent confidence interval, 1.02 to 1.47) for the continuously uninsured participants and 1.26 (95 percent confidence interval, 1.01 to 1.54) for the intermittently uninsured participants. CONCLUSIONS: The lack of health insurance is associated with an increased risk of a decline in overall health among adults 51 to 61 years old.

Antihypertensive medication use in Hispanic adults: a comparison with black adults and white adults.

BACKGROUND: Variations in awareness, treatment, and control of hypertension among different racial/ethnic groups have been widely reported. It is unclear whether these differences are explained fully by differences in socioeconomic status, insurance coverage, health status, and health behaviors, or whether these differences indicate that racial/ethnic subgroups have unique barriers to hypertension control. OBJECTIVES: Determine whether there are significant differences between racial/ethnic groups in medication use for hypertension after adjusting for potentially confounding variables. RESEARCH DESIGN: Cross-sectional analysis of the 1992 Health and Retirement Study. SUBJECTS: 2450 non-Hispanic white, 939 non-Hispanic black, and 345 Hispanic participants, ages 51 to 61, reporting a history of hypertension. MEASURES: Self-reported current antihypertensive medication use. We used logistic regression to adjust for demographics, socioeconomic status, health status, insurance, and health risk behaviors. RESULTS: 63.6% of white adults, 72.6% of black adults, and 52.5% of Hispanic adults reported current medication use to control hypertension (P <0.001 across all three groups). In stratified analysis, the lower rate of use for Hispanic adults was consistent regardless of gender, insurance coverage, or health status. After controlling for all variables, the adjusted prevalence for Hispanic adults was 50.8% and 73.3% for black adults. CONCLUSIONS: The differences in antihypertensive medication use between white adults, black adults, and Hispanic adults, particularly the markedly lower rates among Hispanic adults, are not explained by differences in demographics, socioeconomic status, health insurance coverage, health status, or health risk behaviors. Alternative explanations for these results and areas for future research and intervention are explored.

The association between age and health literacy among elderly persons.

OBJECTIVE: To examine why older age groups have worse functional health literacy. METHODS: Home interviews were conducted with community-dwelling elderly persons (n = 2,774) to determine demographics, years of school completed, newspaper reading frequency, chronic diseases, and health status. Participants completed the Short Test of Functional Health Literacy in Adults (S-TOFHLA, range 0-100) and the Mini Mental State Examination (MMSE). RESULTS: Mean S-TOFHLA scores declined 1.4 points (95% CI 1.3-1.5) for every year increase in age (p < .001). After adjusting for sex, race, ethnicity, and education, the S-TOFHLA score declined 1.3 points (95% CI 1.2-1.4) for every year increase in age. Even after adjustment for performance on the MMSE, the S-TOFHLA score declined 0.9 points (95% CI 0.8-1.0) for every year increase in age (p < .001). Differences in newspaper reading frequency, visual acuity, chronic medical conditions, and health status, did not explain the lower literacy of older participants. DISCUSSION: Functional health literacy was markedly lower among older age groups even after adjusting for differences in MMSE performance, newspaper reading frequency, health status, and visual acuity. Future studies should prospectively examine whether functional literacy declines with age and whether this is explained by declines in cognitive function.