Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 214

Education plays a key role in overcoming the effects of poor health literacy. If health information is shared via spoken instruction, it is best to remember that older adults understand medical information better when they are spoken to slowly, simple words are used, and a restricted amount of information is presented. Often, health literacy is addressed using written materials. However, in the United States, many older adults read at an eighth‐grade level, and 20% of the population reads at or below a fifth‐grade level. A study of 177 low‐income, community‐dwelling older adults (with no cognitive or visual impairments) was carried out to determine whether they had difficulty understanding written information provided by clinicians. The subjects’ mean reading skills were at a fifth‐grade level, below those of the general American population. One‐quarter of subjects reported difficulty in understanding written information from clinicians.²⁰ However, most health care materials are written at a tenth‐grade level.¹⁰ Healthcare providers must identify older adults with marginal or inadequate health literacy and adjust their health care education strategies to meet these literacy needs. For optimal comprehension and compliance, patient education material should be written at a sixth‐grade or lower reading level, preferably including pictures and illustrations.¹⁴

It is also important to provide instruction in the language in which the patient is most fluent. For example, compared to those with adequate and marginal health literacy, women with inadequate functional health literacy in Spanish were significantly less likely to have ever had a Papanicolaou (Pap) test.²¹ Of course, having assessment tools translated into the original language does not solve health literacy problems. In Turkey, risk factors for the lowest levels of health literacy include being female educated at the primary school level, in poor economic conditions, and older.²² In California, Cordasco, et al.²³ compared by age levels of health literacy, educational attainment, English comprehension, and language use in inpatients. They found that the prevalence of inadequate health literacy increased significantly with increasing age. The correlation between older age and lower health literacy persisted when controlling for educational achievement, race, ethnicity, gender, and immigration status. Additionally, older adults were more likely to have never learned to read, have no formal education, have limited English comprehension, and speak a non‐English language at home. This suggests that providers should develop and use low‐literacy educational materials, programmes, and services to meet the chronic disease needs of an older, multiethnic population and ameliorate the negative health effects of associated low literacy.²³

Differences in mental health literacy across the adult lifespan suggest that more specific, age‐appropriate messages about mental health are required for different age groups.¹⁹ Care must be taken to tailor material to the audience to optimise understanding. This means providers should ensure that the material does not exceed the users’ literacy level and that any translated materials are sensitive to the culture of the target population.²⁴