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Introduction¹

Adults age 65 and older² make up the fastest-growing segment of the U.S. population. The U.S. Census Bureau projects that between 2012 and 2050, the number of older adults will reach 83.7 million persons, nearly double the estimated population of 43.1 million in 2012, and account for 20.9 percent of the U.S. population.³ At the same time, the complexity of health care delivery continues to grow, creating challenges that are magnified for older adults, given that age is one of the highest correlates of low health literacy (Baker et al., 2000; Kobayashi et al., 2016). As Bernard Rosof, chief executive officer of the Quality in Health Care Advisory Group, stated in his opening remarks, this creates a shared obligation between health care and the health care team to use the principles, tools, and practices of health literacy so that patients and families of older adults can more easily navigate discussions related to chronic disease, polypharmacy, long-term care, palliative care, insurance complexities, the social determinants of health, and other factors that create challenges for older adults, particularly among underserved populations nationwide. Given the importance of social determinants of health and the added health risks

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¹ This section is based on the presentation by Bernard Rosof, chief executive officer of the Quality in Health Care Advisory Group, and his statements are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.

² In this publication, the generic term “older adult” refers to someone age 65 and older unless specified otherwise.

³ For more information, see www.census.gov/prod/2014pubs/p25-1140.pdf (accessed April 2, 2018).

associated with isolation in older populations, Rosof noted, health literacy in this context encompasses navigation and understanding the available community social services and supports in addition to clinical care.

To gain a better understanding of the health communication challenges among older adults and their professional and family caregivers and how those challenges affect the care older adults receive, the National Academies of Sciences, Engineering, and Medicine’s Roundtable on Health Literacy convened this 1-day public workshop featuring presentations and discussions that examined the effect of low health literacy on the health of older adults.⁴

Rosof noted that the workshop’s presentations and discussions were designed to meet four objectives:

1. Describe the health literacy challenges that older adults face as they try to maintain their health, their independence, and their place in the community.
2. Speak to how the dynamics of family and informal caregivers add a layer of complexity to the health literacy challenges with regard to determining individual needs and preferences.
3. Raise awareness of the changing needs of older adults, as well as the new and challenging language and systems they must deal with, including those in health and community services and technology.
4. Highlight strategies to bridge health literacy gaps that directly impact the health and quality of life for older adults.

ORGANIZATION OF THE PROCEEDINGS

The workshop (see Appendix A for the Workshop Agenda) was organized by an independent planning committee in accordance with the procedures of the National Academies. This publication summarizes the discussions that occurred throughout the workshop and highlights the key lessons presented, practical strategies, and the needs and opportunities for improving health literacy among older adults in the United States, as well as for their caregivers and family members (see Box 1-1 for the Statement of Task). Chapter 2 reviews the current landscape regarding health literacy in older adults. Chapter 3 discusses health literacy in the context of families and the community and how improved health literacy can reduce disparities in care and foster independence among older adults. Chapter 4 looks at how health care systems can use health literacy principles and tools to improve health system navigation, as well as how technology can be either

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⁴ The planning committee focused on English-speaking older adults living in the United States.

a facilitator or a barrier for older adults. Chapter 5 recounts a moderated discussion about the day’s presentations and presents the roundtable’s reflections on the key lessons learned at this workshop.

In accordance with the policies of the National Academies, the workshop did not attempt to establish any conclusions or develop recommendations about needs and future directions, focusing instead on issues identified by the speakers and workshop participants. In addition, the organizing committee’s role was limited to planning the workshop. This Proceedings of a Workshop was prepared by workshop rapporteur Joe Alper as a factual summary of what occurred at the workshop.

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