HEALTH
LITERACY AND
OLDER ADULTS
RESHAPING THE
LANDSCAPE
PROCEEDING OF A WORKSHOP
Joe Alper, Rapporteur
Roundtable on Health Literacy
Board on Population Health and Public Health Practice
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by contracts between the National Academy of Sciences and Abbvie Inc.; Aetna Foundation; American Dental Association; Bristol-Myers Squibb; East Bay Community Foundation (Kaiser Permanente); Eli Lilly and Company; Health Literacy Media; Health Literacy Partners; Health Resources and Services Administration (HHSH25034011T); Humana; Institute for Healthcare Advancement; Merck Sharp & Dohme Corp.; National Library of Medicine; New York University Langone Medical Center; Northwell Health; Office of Disease Prevention and Health Promotion (HHSP23337043); Pfizer Inc.; and UnitedHealth Group. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-47946-2
International Standard Book Number-10: 0-309-47946-0
Digital Object Identifier: https://doi.org/10.17226/25188
Additional copies of this publication are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.
Copyright 2018 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Health literacy and older adults: Reshaping the landscape: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25188.
The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.
The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.
The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.
The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.
Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.
Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.
Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.
For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.
PLANNING COMMITTEE ON HEALTH LITERACY AND OLDER ADULTS: RESHAPING THE LANDSCAPE1
AMY K. CHESSER, Assistant Professor, Wichita State University
ANNA CHODOS, Assistant Professor, University of California, San Francisco, School of Medicine
DEIDRA C. CREWS, Associate Vice Chair for Diversity and Inclusion and Associate Professor of Medicine, Johns Hopkins University School of Medicine
LINDA HARRIS, Director, Division of Health Communication and eHealth, Office of Disease Prevention and Health Promotion, Department of Health and Human Services
SHANNAH KOSS, President, Koss on Care, LLC
TERRI ANN PARNELL, Principal and Founder, Health Literacy Partners
RIMA RUDD, Senior Lecturer on Health Literacy, Education, and Policy, Harvard T.H. Chan School of Public Health
YOLANDA TAYLOR BRIGNONI, Integrated Strategic Communications Director, AARP
JENNIFER WOLFF, Professor of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution.
This page intentionally left blank.
ROUNDTABLE ON HEALTH LITERACY1
BERNARD M. ROSOF (Chair), Chief Executive Officer, Quality in Health Care Advisory Group, LLC; and Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
ANNLOUISE R. ASSAF, Enterprise Benefit Risk Medical Director, Pfizer Inc.
SUZANNE BAKKEN, Alumni Professor of Nursing and Professor of Biomedical Informatics, Columbia University
AMY A. CLARK, Director, Cultivating Health Communities, Aetna Foundation
GEMIRALD P. DAUS, Public Health Analyst, Office of Health Equity, Health Resources and Services Administration
TERRY C. DAVIS, Professor of Medicine and Pediatrics, Louisiana State University Health Sciences Center
CHRISTOPHER DEZII, Director, Healthcare Quality and Performance Measures, Bristol-Myers Squibb
JENNIFER A. DILLAHA, Medical Director for Immunizations, Medical Advisor, Health Literacy and Communication, Arkansas Department of Health
JAMES DUHIG, Head, Risk Communication and Behavioral Systems, Office of Patient Safety, AbbVie Inc.
ALICIA FERNANDEZ, Professor of Clinical Medicine, Department of Medicine, Division of General Internal Medicine, University of California, San Francisco
LISA FITZPATRICK, Senior Medical Director, DC Department of Health Care Finance; and Professorial Lecturer, George Washington University Milken Institute School of Public Health
LORI K. HALL, Director, Health Literacy, Global Medical Strategy and Operations, Eli Lilly and Company
LINDA HARRIS, Director, Division of Health Communication and eHealth, Office of Disease Prevention and Health Promotion, Department of Health and Human Services
NICOLE HOLLAND, Assistant Professor and Director of Health Communication, Education, and Promotion, Tufts University School of Dental Medicine
JOAN KELLY, Chief Patient Experience Officer, New York University Langone Medical Center
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution.
ELLEN M. MARKMAN, Lewis M. Terman Professor of Psychology, Stanford University
MICHAEL M. McKEE, Assistant Professor of Family Medicine, University of Michigan Medical School
LAURIE MYERS, Global Health Literacy Director, Merck Sharp & Dohme Corp.
CATINA O’LEARY, President and Chief Executive Officer, Health Literacy Media
MICHAEL K. PAASCHE-ORLOW, Professor of Medicine, Boston University School of Medicine
TERRI ANN PARNELL, Principal and Founder, Health Literacy Partners
KIM PARSON, Strategic Consultant, Proactive Care Strategies, Humana
LINDSEY A. ROBINSON, Thirteenth District Trustee, American Dental Association
STEVEN RUSH, Director, Health Literacy Innovations, UnitedHealth Group
OLAYINKA SHIYANBOLA, Assistant Professor, Division of Social and Administrative Sciences, Univeristy of Wisconsin–Madison School of Pharmacy
VANESSA SIMONDS, Assistant Professor, Community Health, Montana State University
MICHAEL VILLAIRE, Chief Executive Officer, Institute for Healthcare Advancement
EARNESTINE WILLIS, Kellner Professor in Pediatrics, Medical College of Wisconsin
AMANDA J. WILSON, Head, National Network Coordinating Office, National Library of Medicine
MICHAEL S. WOLF, Professor, Medicine and Learning Sciences, Associate Division Chief, Research Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University
WINSTON F. WONG, Medical Director, Disparities Improvement and Quality Initiatives, Kaiser Permanente
Health and Medicine Division Staff
LYLA M. HERNANDEZ, Senior Program Officer
MELISSA G. FRENCH, Program Officer
ALEXIS WOJTOWICZ, Senior Program Assistant
ROSE MARIE MARTINEZ, Senior Board Director, Board on Population Health and Public Health Practice
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by NANCY FUGATE WOODS, University of Washington. She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies.
This page intentionally left blank.
Acknowledgments
The sponsors of the Roundtable on Health Literacy made it possible to plan and conduct the workshop on Health Literacy and Older Adults: Reshaping the Landscape, which this proceedings summarizes. Federal sponsors from the Department of Health and Human Services are the Health Resources and Services Administration; National Library of Medicine; and Office of Disease Prevention and Health Promotion. Nonfederal sponsorship was provided by AbbVie Inc.; Aetna Foundation; American Dental Association; Bristol-Myers Squibb; East Bay Community Foundation (Kaiser Permanente); Eli Lilly and Company; Health Literacy Media; Health Literacy Partners; Humana; Institute for Healthcare Advancement; Merck Sharp & Dohme Corp.; New York University Langone Medical Center; Northwell Health; Pfizer Inc.; and UnitedHealth Group.
The workshop presentations were interesting and stimulated much discussion, and the Roundtable on Health Literacy would like to thank each of the speakers and moderators for their time and effort. Speakers and moderators were Amy K. Chesser, Deidra Crews, Z. Colette Edwards, Susan Goodman, Lisa Gualtieri, Shannah Koss, Terri Ann Parnell, Bernard M. Rosof, Rima Rudd, Nora Super, Yolanda Taylor Brignoni, Stephen B. Thomas, Anne Tumlinson, Jennifer Wolff, and Mary Ann Zimmerman.
This page intentionally left blank.
Contents
Organization of the Proceedings
What Do We Know About Health Literacy and Older Adults?
3 THE FAMILY AND COMMUNITY LANDSCAPE
Giving Voice to Older Adults and Caregivers: Difficult Conversations and Decisions
Health Literacy as a Tool to Ease Disparities Among Vulnerable Older Adults
Community Living, Fostering Engagement, and Independence
Navigating Long-Term Services and Supports
Box, Figures, and Table
BOX
FIGURES
3-1 Population aging is a global phenomenon
3-3 Patient motivations for sharing access to the patient portal of an integrated health system
3-4 Comparing patients and their care partners
4-1 Functional impairment drives health care costs
4-2 Medicaid eligibility among seniors who need LTSS
4-3 Distribution of costs associated with paid care to provide LTSS
4-4 LTSS need leads to a wide range of decisions to make
4-5 Percentage of U.S. adults who would be willing to use an app to measure health metrics
TABLE
2-1 Results of a Literature Review on Health Literacy and Older Adults
This page intentionally left blank.
Acronyms and Abbreviations
| AAA | Area Agency on Aging |
| BRFSS | Behavioral Risk Factor Surveillance System |
| EHR | electronic health record |
| HAIR | Health Advocates In-Reach and Research |
| HIPAA | Health Insurance Portability and Accountability Act |
| LTSS | long-term services and supports |
| n4a | National Association of Area Agencies on Aging |
| REALM | Rapid Estimate of Adult Literacy in Medicine |
| S-TOFHLA | Short Test of Functional Health Literacy in Adults |
| TOFHLA | Test of Functional Health Literacy in Adults |
This page intentionally left blank.
