Regular Research Article| Volume 29, ISSUE 9, P972-981, September 2021

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Aging and Functional Health Literacy: A Population-based Study

Published:December 11, 2020DOI:


      • What is the primary question addressed by this study?This study addressed the distribution and associated factors of functional health literacy measured by the Short Test of Functional Health Literacy (S-TOFHLA) in an older, population-based cohort.
      • What is the main finding of this study?The main finding was that 7% of the older adults had inadequate or marginal health literacy. These individuals were older, male, and had low reading levels.
      • What is the meaning of the finding?Clinicians should be aware of patients’ functional health literacy and tailor their communications accordingly.



      To investigate functional health literacy and its associated factors among older adults drawn from a disadvantaged area.


      Cross-sectional epidemiologic study.


      Population-based cohort randomly selected from the voter registration lists.


      Individuals aged 65+ (N=1066).


      The Short Test of Functional Health Literacy in Adults (S-TOFHLA); demographics; self-rated health; number of prescription drugs; modified Center for Epidemiologic Studies- Depression scale; Mini-Mental State Examination; Wechsler Test of Adult Reading; Clinical Dementia Rating; cognitive domain composite scores; independence in Instrumental Activities of Daily Living and medication management; health services utilization (emergency/urgent care visits and hospitalizations).


      Low (inadequate or marginal) S-TOFHLA scores were obtained by 7.04% of the sample. In unadjusted analyses, participants with low S-TOFHLA scores were significantly more likely than those with higher scores to be older, male, non-White, with lesser education and lower household income, to have lower scores on the Wechsler Test of Adult Reading, the Mini-Mental State Examination, and all cognitive domains; to be more dependent in Instrumental Activities of Daily Living and be taking more prescription drugs. In a multiple regression model including all covariates, only older age, male sex, and lower reading level were independently associated with inadequate or marginal S-TOFHLA scores.


      In a population-based sample of older adults, low functional health literacy was associated with age, sex, education, and reading ability. Basic functional health literacy is essential for understanding health information and instructions. Clinicians should formally or informally assess health literacy in their older patients to ensure effective communication and enhance health outcomes.

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