Hispanic Elderly Patients and Their Caregivers Essay
Hispanic Elderly Patients and Their Caregivers Essay
The modern health care sector faces numerous problems that come from the peculiarities of the environment and peoples mentality. Besides, the alteration of food habits, usage of numerous substitutes combined with the high paces of life resulted in the appearance and evolution of chronic diseases which became one of the most threatening health issues. For this reason, a great need for patient-oriented education exists nowadays. Hispanic Elderly Patients and Their Caregivers Essay. In this regard, the following PICO question becomes especially topical:
In elderly patients with chronic diseases does patient education intervention compared with only medication treatments increase their health knowledge and improve their health statuses. Hispanic Elderly Patients and Their Caregivers Essay.
It could be used to distinguish the most important variables, research the issue, and create the basis for the credible conclusion.
Dependent variable
Considering the aspects touched upon by this question, we could state that the education intervention and medication treatments are obviously independent variables. These interventions are provided to attain certain alteration of the quality of patients lives and improvement of their health. Additionally, the ways these methods are used, the number of repetitions, the effect, and other showings are strongly fixed. This pattern is explored to monitor the course of the experiment and trace alterations that are triggered by highly restricted amounts of these variables. Additionally, it might help to compare the final result and admit the efficiency of one or another measure. Hispanic Elderly Patients and Their Caregivers Essay.
ORDER A PLAGIARISM -FREE PAPER NOW
Independent variable
In this regard, health knowledge and status should be considered dependent variables. The above-mentioned PICO question introduces the research pattern according to which these aspects should be investigated by applying either health education activities or medical treat ments. That is why we could expect alterations of final results preconditioned by the differences in health benefits and effects caused by two different approaches. Considering the fact that both health knowledge and status will not be the same at the beginning and end of the investigation, we could conclude that these might be taken dependent variables investigated in the course of the experiment.Related studies
Therefore, the importance of the issue results in the appearance of numerous researches aiming at the significant improvement of its comprehending.Hispanic Elderly Patients and Their Caregivers Essay. For instance, Garcia, Espinoza, Lichtenstein and Hazuda (2013) in their research are sure that “knowing health literacy levels of older patients and their caregivers is important because caregivers assist patients in the administration of medications, manage daily health care tasks, and help make health services utilization decisions” (p. 256). To prove this statement, the authors investigated the existing correlation between Hispanic patients literacy levels and final outcomes and came to the conclusion that the provision of optimal care is possible only in case the information is provided to patients in clear and effective way which is possible only if they have an appropriate level of health knowledge.
Souza et al. (2014) also delve into this very issue and try to investigate the relationship between the level of health literacy and health outcomes in patients suffering from type 2 diabetes. Having conducted the research, they come to a conclusion that “patients with inadequate functional health literacy were more likely than patients with adequate functional health literacy to present poor glycaemic control” (p. 1) and that is why they were expected to have better outcomes.
Conclusion
In this regard, we could conclude that the investigation of the given issue is crucial, as health literacy has an overwhelming impact on patients health and outcomes and it is vital to aim at its further improvement.
References
Garcia, C. H., Espinoza, S. E., Lichtenstein, M., & Hazuda, H. P. (2013). Health literacy associations between Hispanic elderly patients and their caregivers. Journal of Health Communication, 18(1), 256-272. Hispanic Elderly Patients and Their Caregivers Essay.
Souza, J. G., Apolinario, D., Magaldi, R. M., Busse, A. L., Campora, F., & Jacob-Filho, W. (2014). Functional health literacy and glycaemic control in older adults with type 2 diabetes: a cross-sectional study. BMJ Open, 4(2), 1-8.
Knowing health literacy levels of older patients and their caregivers is important because caregivers assist patients in the administration of medications, manage daily health care tasks, and help make health services utilization decisions. The authors examined the association of health literacy levels between older Hispanic patients and their caregivers among 174 patient-caregiver dyads enrolled from 3 community clinics and 28 senior centers in San Antonio, Texas. Health literacy was measured using English and Spanish versions of the Short-Test of Functional Health Literacy Assessment and categorized as “low” or “adequate.” The largest dyad category (41%) consisted of a caregiver with adequate health literacy and patient with low health literacy. Among the dyads with the same health literacy levels, 28% had adequate health literacy and 24% had low health literacy. It is notable that 7% of dyads consisted of a caregiver with low health literacy and a patient with adequate health literacy. Low health literacy is a concern not only for older Hispanic patients but also for their caregivers. To provide optimal care, clinicians must ensure that information is given to both patients and their caregivers in clear effective ways as it may significantly affect patient health outcomes.
Low health literacy is a major problem in the United States. It is estimated that approximately 80 million people in the United States have limited health literacy (Berkman, Sheridan, Donahue, Halpern, & Crotty, 2011). On the basis of the Institute of Medicine’s definition, this is defined as a limited “capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Institute of Medicine, 2011; Ratzan & Parker, 2000). The 2003 National Assessment of Adult Literacy survey, which used the Institute of Medicine’s definition, reported that nearly 1 in 6 Americans possess only the most simple health literacy skills (Kutner, U.S. Department of Education, & National Center for Education Statistics, 2006). Hispanic Elderly Patients and Their Caregivers Essay. A 2003–2011 systematic review of the English language literature documented that patients with low health literacy compared with patients whose health literacy is adequate have worse health outcomes, more hospitalizations and emergency room use, and fewer health maintenance and preventative medicine services, such as mammography screenings and immunizations (Berkman et al., 2011). Proceedings from the Surgeon General’s workshop on improving health literacy also noted the strong association between low health literacy and poor health outcomes, such as emergency department use, hospitalization, self-reported health, and mortality (Office of the Surgeon General and the Office of Disease Prevention and Health Promotion, 2006). Economists estimate that the adverse consequences of low health literacy add $106 billion to $238 billion annually to U.S. health care costs (Vernon, Trujillo, Rosenbaum, & DeBuono, 2007).
Hispanics are disproportionately represented among persons with low health literacy and, in 2003, comprised 41% of U.S. adults with below basic health literacy (Kutner, 2006). Older Hispanics—the fastest growing subgroup among older U.S. adults (Federal Interagency Forum On Aging-Related Statistics, 2010)—are at greater risk than younger Hispanics of having inadequate health literacy (Kutner, 2006). A study of 414 older adults older than 60 years of age living in New York City found that among those with inadequate health literacy, more than half were Hispanic (Federman, Sano, Wolf, Siu, & Halm, 2009). Compounding the problem of low health literacy, older Hispanics are more likely than older European Americans are to report functional limitations and disabilities (Carrasquillo, Lantigua, & Shea, 2000; Ostchega, Harris, Hirsch, Parsons, & Kington, 2000). However, older Hispanics are less likely than European Americans are to use community-based long-term care services (Aranda & Knight, 1997); instead, they frequently rely on informal caregivers such as spouses, family members, or friends (Weiss, Hector, Mohammed, & Kenneth, 2005). Hispanic Elderly Patients and Their Caregivers Essay.
As persons age, the onset of cognitive impairment erodes the capacity to comprehend and act on health information. Given that advancing age is a correlate of low health literacy (Baker, Gazmararian, Sudano, & Patterson, 2000), the presence of a caregiver may safeguard individuals in assuring their effective use of health services. Caregivers play a major role in encouraging medication adherence, interpreting medical information, communicating with providers, making decisions about when to seek medical treatment, learning and performing technical procedures (e.g., wound care), and acting as translators for patients who are not proficient in English (Bevan & Loretta, 2008). Nonetheless, little is known about the caregiver’s health literacy, its association with the patient’s health literacy, and its potential effect on the capacity of the dyad to use health services effectively for the older adult. Although there are several studies on the health literacy of caregivers of children, there is only one published study that examined the health literacy of paid caregivers of older adults, which reported that the rate of low health literacy in this group of caregivers is high (Lindquist, Jain, Tam, Martin, & Baker, 2010).
The purpose of the present study was to measure the level of health literacy among dyads of Hispanic older adults (patients) and their caregivers to determine the patterns of association within dyads and the correlates of low health literacy in both patients and their caregivers. Hispanic Elderly Patients and Their Caregivers Essay. Many clinicians assume that caregivers will have the same or greater level of health literacy when compared with the patient. Therefore, we hypothesized that low or high levels of health literacy among caregivers would be associated with matching low or high levels of health literacy in their patients.
Method
Patients
We recruited 174 patient–caregiver dyads from outpatient clinics (70 dyads) and community senior centers (104 dyads) in San Antonio, Texas, from November 2010 to August 2011. Outpatient clinics included (a) the Veterans Administration Geriatric Evaluation and Management clinic, (b) the CHRISTUS Santa Rosa Senior Health Clinic in downtown San Antonio, and (c) the University of Texas Medical Arts and Research Center Geriatrics Clinic. Individuals were recruited in clinics using informational flyers at the time of clinic check-in and also by primary care physician referral to the study team. Community senior centers included 28 centers in socioeconomically diverse locations across San Antonio. Individuals recruited through community centers were recruited with the use of flyers and brochures available in the center as well as informational presentations made by a member of the study team (C.G.).
Data were collected through 45-minute in-person interviews. Interviews were conducted by trained, bilingual staff using standardized protocols and administered in English or Spanish (on the basis of the participant’s stated preference). Participants were given the option of doing the interview on site (where recruited) or in their homes. Study visits comprised three parts: (a) an oral interview to obtain demographic data, (b) assessments of health status and acculturation, and (c) a self-administered measurement of health literacy.
Inclusion criteria were the following: (a) being a community-dwelling older adult (65 years of age or older) who (b) had a caregiver and (c) self-identified as Hispanic. Hispanic Elderly Patients and Their Caregivers Essay. At clinic sites, the patient was defined as the individual being served by the health providers. In senior centers, dyads were identified; then, the patient was defined as the individual who acknowledged receiving greater care and support (instrumental, physical, emotional, and mental) from the other dyad member. Caregivers had to be at least 18 years old but could be from any ethnic group. Both patient and caregiver had to agree to participate.
Exclusion criteria were as follows: (a) vision score worse than 20/100 using the Rosenbaum handheld eye chart, (b) score less than 18 on the Mini-Mental State Examination (MMSE; Folstein, Folstein, & McHugh, 1975) or (c) too ill to participate. The Institutional Review Board of the University of Texas Health Science Center San Antonio approved the study, and all participants gave informed consent.
Measures
Age
Age was self-reported by patients and caregivers and described both as a continuous and categorical variable collapsed into four groups: <65, 65–70, 71–80, and >80 years. Age was used as a categorical variable in the multivariable model.
Education Level
The highest number of years of schooling completed was obtained by self-report. Years of education were described both as a continuous and categorical variable (less than high school, high school graduate, some college, and college graduate). In the multivariable model, education was included as a categorical variable.
Caregiver Relationship
Caregiver’s relationship to the patient was ascertained by caregiver self-report. Categories included spouse/partner (n = 111), family member (n = 49), hired caregiver (n = 8), and unpaid friend (n = 6). In the multivariable model, caregiver was treated as a dichotomous variable categorized as a spouse/partner relationship versus any other relationship (family member, hired caregiver, or friend).Hispanic Elderly Patients and Their Caregivers Essay.
Vision
Binocular, corrected vision was treated as a continuous variable. Vision was assessed in a well-lit area using a Rosenbaum Handheld Vision Chart (range = 20/20 to 20/100). Higher numbers in the range represent poorer vision. Participants were asked to read the smallest line they could see. If more than two mistakes were made, they were asked to read the next largest line.
MMSE
Cognitive function was assessed using the MMSE (range = 0–30), available in English and Spanish. MMSE was treated as a continuous variable, with higher scores indicating better cognitive function. (Espino, Lichtenstein, Palmer, & Hazuda, 2001, 2004; Folstein et al., 1975).
Depressive Symptoms
Depressive symptoms were evaluated using the 15-item version of the Geriatric Depression Scale (range = 0–15; D’Ath, Katona, Mullan, Evans, & Katona, 1994) available in English and Spanish (Ortega Orcos, Salinero Fort, Kazemzadeh Khajoui, Vidal Aparicio, & de Dios del Valle, R., 2007). The Geriatric Depression Scale was treated as a continuous variable, with higher scores indicating presence of greater depressive symptoms.
Acculturation
Acculturation was defined as a multidimensional process in which individuals whose primary learning has been in one culture (e.g., the Mexican or Mexican-American culture) take over characteristic ways of living (i.e., language, attitudes, values, and behavior) from another culture (e.g., the broader American culture). Because we believed that language usage was the most salient dimension to assess relative to health literacy, we measured that dimension of acculturation with the 10-item Hazuda Adult English versus Spanish Language Usage scale, (Hazuda, Haffner, Stern, & Eifler, 1988), which assesses the language an individual uses with family members, friends, neighbors, and coworkers, as well as the language of the TV shows they watch, radio stations they listen to, and books they read. The instrument is validated in both English and Spanish. Hispanic Elderly Patients and Their Caregivers Essay.Item responses are as follows: only Spanish, mostly Spanish, Spanish and English equally, mostly English, and only English. Scores range from 0 to 50 (higher scores indicate greater use of English relative to Spanish-language usage) and are categorized into four rank-ordered strata from least (lowest strata) to most acculturated (highest strata). The four rank-ordered strata (range = 1–4) were treated as a linear trend variable.
Health Literacy Level
Health literacy was measured using the reading portion of the Short Test of Functional Health Literacy Assessment (S-TOFHLA). The S-TOFHLA takes approximately 7 minutes to complete and is validated in both English and Spanish (Baker, Williams, Parker, Gazmararian, & Nurss, 1999). The 36-item S-TOFHLA uses a modified Cloze procedure to measure reading comprehension. It consists of two reading passages: one about preparation for an upper GI series (written at the 4th-grade level), the second about patients’ rights and responsibilities from a Medicaid application form (written at the 10th-grade level). Score range is 0–36, with higher scores indicating better literacy. Scores are stratified into inadequate (0–16), marginal (17–22), or adequate health literacy (23–36) (Nurss, Parker, Williams, & Baker, 1998). Individuals with marginal or inadequate health literacy will have difficulty reading, understanding, and interpreting most written health materials (Nurss et al., 1998). Because of the skewed distribution of S-TOHFLA categories in our sample, we combined marginal and inadequate scores into a single “low” health literacy category (0–22), which we compared with the “adequate” category (23 36). At the beginning of the interview, participants were asked in which language they wished to be interviewed, and in which language they preferred to receive written health forms. Hispanic Elderly Patients and Their Caregivers Essay. Their answer to the latter question determined the language in which the S-TOFHLA was administered. The majority of patients and caregivers took the interview and S-TOFHLA in the same language (English or Spanish). Only 2 patients and 1 caregiver completed the interview and the self-administered S-TOFHLA in different languages. All three participants completed the interview in Spanish, and the S-TOFHLA in English. All survey instruments were available in both English and Spanish.
Statistical Analysis
Patient and caregiver characteristics were analyzed using either Fisher’s exact test or the chi-squared statistic, as appropriate, for categorical variables and the two-sample ttest statistic for continuous variables (Kirkwood & Sterne, 2003). Consistency, or matching, of health literacy levels within dyads was assessed using continuous and categorical measures of health literacy. Differences in all patient and caregiver characteristics by recruitment site (clinic vs. senior center) were also examined using ttests for continuous variables and chi-square statistics for categorical variables. Intraclass correlation coefficients were used to correlate continuous S-TOFHLA scores between patients and their caregivers; kappa statistics were used to compare categorical S-TOFHLA levels (Kirkwood & Stern, 2003). Univariate and multivariate logistic regression were used to examine the relationship between factors potentially associated with low health literacy among patients and caregivers (Kirkwood & Stern, 2003). Low health literacy was regressed on age category, gender, education category, acculturation strata, interview language, spousal relationship, MMSE score, corrected vision score, and recruitment site. Analyses were performed with STATA/SE 11.1 (STATA Corp., College Station, TX).Hispanic Elderly Patients and Their Caregivers Essay.
Results
Compared with patients (Table 1), caregivers were more likely to be younger, female, spouses, more educated, and more acculturated. Caregivers also had better corrected vision and higher MMSE scores than patients. Both groups had little evidence of depressive symptoms; however, patients recruited in the clinic had higher scores on the Geriatric Depression Scale compared with patients recruited from senior centers. Participants who interviewed in Spanish were less educated and less acculturated than those who interviewed in English. Overall, caregivers had higher mean S-TOFHLA scores and higher prevalence of adequate health literacy compared with patients. Further, caregivers recruited from senior centers compared with those recruited from the clinics were more likely to be older, less educated, and less acculturated. They also had lower scores on the Mini Mental State Exam, were more likely to have taken the interview in Spanish, and had lower health literacy compared with caregivers recruited from the clinics.Hispanic Elderly Patients and Their Caregivers Essay.
Table 1.
Characteristics and health literacy levels of Hispanic elderly patients and their caregivers, by recruitment site
| Clinic
|
Senior center*
|
|||||
|---|---|---|---|---|---|---|
| Patients (n = 70) M (SD) or n(%) | Caregivers (n = 70) M(SD) or n(%) | p value for difference between patients and caregivers | Patients (n = 104) M(SD) or n(%) | Caregivers (n = 104) M (SD) or n (%) | p value for difference between patients and caregivers | |
| Age, years (range = 30–96) | 75.5 (6.8) | 57.2 (14.5)a | <.0001 | 75.1 (6.1) | 69.7 (10.2)a | <.001 |
| Age category, n (%) | ||||||
| <65 | 0 (0) | 42 (60)b | <.001 | 0 (0) | 27 (25.9)b | <.001 |
| 65–70 | 16 (22.8) | 13 (18.6) | 28 (26.9) | 24 (23.1) | ||
| 71–80 | 38 (54.3) | 11 (22.5) | 51 (49.0) | 40 (38.5) | ||
| >80 | 16 (22.9) | 4 (5.7) | 25 (24.0) | 13 (12.5) | ||
| Male, n (%) | 27 (39.1)c | 17 (24.6) | .068 | 67 (64.4) | 24 (23.1)c | <.001 |
| Caregiver relationship, n (%) | ||||||
| Spouse/partner | 26 (37.1)d | — | 85 (81.7)d | — | ||
| Family member | 40 (57.1) | 9 (8.7) | ||||
| Hired caregiver | 4 (5.7) | 4 (3.9) | ||||
| Friend (unpaid) | 0 (0) | 6 (5.8) | ||||
| Education, years (range = 0–20) | ||||||
| Overall | 8.7 (4.5) | 12.5 (3.6)e | <.0001 | 8.6 (4.4) | 9.6 (3.8)f | .0849 |
| Spanish speakerf | 6.9 (4.7) | 11.5 (5.7) | .0138 | 4.6 (3.7) | 6.5 (4.0) | .0415 |
| English speakersg | 9.7 (4.1) | 12.8 (3.1) | <.0001 | 10.6 (3.4) | 11.0 (2.7) | .4204 |
| Education category, n (%) | ||||||
| Overall | ||||||
| Less than high school | 46 (65.7) | 17 (24.3)h | <.001 | 60 (57.7) | 51 (49.0)h | .419 |
| High school graduate | 12 (17.1) | 19 (27.1) | 27 (26.0) | 38 (36.5) | ||
| Some college | 8 (11.4) | 18 (25.7) | 14 (13.5) | 13 (12.5) | ||
| College graduate | 4 (5.7) | 16 (22.9) | 3 (2.9) | 2 (1.9) | ||
| Spanish speakers | ||||||
| Less than high school | 19 (76.0) | 5 (20.8) | .034 | 31 (91.2) | 26 (81.3) | .283 |
| High school graduate | 2 (8.0) | 1 (8.3) | 3 (8.8) | 4 (12.5) | ||
| Some college | 3 (12.0) | 1 (8.3) | 0 (0) | 2 (6.2) | ||
| College graduate | 1 (4.0) | 5 (41.7) | 0 (0) | 0 (0) | ||
| English speakers | ||||||
| Less than high school | 27 (60.0) | 12 (20.7) | <.001 | 29 (41.4) | 25 (34.7) | .466 |
| High school graduate | 10 (22.2) | 18 (31.0) | 24 (34.3) | 34 (47.2) | ||
| Some college | 5 (11.1) | 17 (29.3) | 14 (20.0) | 11 (15.3) | ||
| College graduate | 0 (0) | 2 (2.8) | ||||
| Acculturation | 2.4 (1.0) | 3.1 (0.9)i | <.0001 | 2.4 (1.0) | 2.4 (1.0)i | 1.00 |
| Acculturation level, n (%) | ||||||
| Strata 1 | 19 (27.1) | 5 (7.1)j | <.001 | 25 (24.0) | 23 (22.1)j | .214 |
| Strata 2 | 11 (15.7) | 9 (12.9) | 18 (17.3) | 27 (26.0) | ||
| Strata 3 | 34 (48.6) | 33 (47.1) | 51 (49.0) | 39 (37.5) | ||
| Strata 4 | 6 (8.6) | 23 (32.9) | 10 (9.6) | 15 (14.4) | ||
| Vision (20/X) | 38.3 (18.1) | 29.4 (13.8) | .0013 | 40.7 (20.1) | 30.6 (10.1) | <.0001 |
| Mini Mental State Exam score (range = 0–30) | 25.0 (3.5) | 28.6 (1.2)k | <.0001 | 25.0 (3.3) | 26.8 (3.0)k | .0001 |
| Geriatric Depression Scale score (range = 0–15) | 1.9 (2.3)l | 1.7 (2.8) | .6931 | 0.7 (1.2)l | 1.2 (2.0) | .0662 |
| Language S-TOFHLA administered (%) | ||||||
| English | 45 (64.3) | 58 (82.9)m | .013 | 70 (67.3) | 72 (69.2)m | .766 |
| Spanish | 25 (35.7) | 12 (17.1) | 34 (32.7) | 32 (30.8) | ||
| S-TOFHLA score (range = 0–36) | 16.1 (12.9) | 30.1 (7.8)n | <.0001 | 17.0 (11.3) | 21.8 (11.9)n | .0032 |
| Health literacy level, n (%) | ||||||
| Low (<23) | 45 (64.3) | 8 (11.4)o | <.001 | 68 (65.4) | 46 (44.2)o | .002 |
| Adequate (≥23) | 25 (35.7) | 62 (88.6) | 36 (34.6) | 58 (55.8) | ||
S-TOFHLA = Short Test of Functional Health Literacy Assessment.
*Differences in all patient and caregiver characteristics by recruitment site, clinic versus senior center, were tested using t test for continuous variables and chi-square statistic for categorical variables. If a significant difference was found, the p value is included in a footnote for the individual characteristic. If there is no footnote, no significant difference was found.
Table 2 documents the proportions of patients and caregivers with low health literacy overall and stratified by the language in which the patient completed the self-administered S-TOFHLA. Among the dyads, 52.3% (n = 91; 49 + 42) were composed of patients and caregivers with the same level of health literacy, whereas 47.7% (n = 83; 12 + 71) were composed of patients and caregivers who differed in their level of health literacy. The largest dyad category was the caregiver adequate-patient low health literacy group (n = 71; 41%), followed by the caregiver adequate-patient adequate health literacy group (n = 49; 28%), and the caregiver low-patient low health literacy group (n = 42; 24%). A small proportion (n = 12; 7%) of dyads consisted of the caregiver low-patient adequate health literacy group. Hispanic Elderly Patients and Their Caregivers Essay.Concordance of patient and caregiver health literacy levels within dyads was low for both continuous and categorical scores (Spearman’s rho = 0.17 and kappa = 0.16, respectively).
Table 2.
Health literacy levels among older Hispanics and their caregivers
| Language of interview
|
|||
|---|---|---|---|
| Patient and caregiver health literacy level | Total | Spanish | English |
| Patient adequate | n = 61 | n = 9 | n = 52 |
| Caregiver adequate, n (%) | 49 (80.3) | 9 (100.0) | 40 (76.9) |
| Caregiver low, n (%) | 12 (19.7) | 0 (0.0) | 12 (23.1) |
| Patient low | n = 113 | n = 50 | n = 63 |
| Caregiver adequate, n (%) | 71 (62.8) | 22 (44.0) | 49 (77.8) |
| Caregiver low, n (%) | 42 (37.2) | 28 (56.0) | 14 (22.2) |
| p | .017 | .002 | 1.00 |
Older Hispanic patients with low health literacy were somewhat more likely than those with adequate health literacy to also have low health literacy caregivers (37.2% [42/113] vs. 19.7% [12/61]). This appears to be attributable entirely to differences in caregivers’ health literacy associated with their patients’ interview language. A third (33.9%; n = 59) of the patients interviewed in Spanish; among these, 50 of 59 (84.7%) had low health literacy. Spanish-interview patients with low health literacy were much more likely to have caregivers with low health literacy compared with Spanish-interview patients with adequate health literacy (56.0% [28/50] vs. 0.0% [0/9]). In contrast, slightly more than half (54.8%, 63/115) of the patients who interviewed in English had low health literacy, but there was no association between their health literacy and that of their caregiver.
ORDER A PLAGIARISM -FREE PAPER NOW
Unadjusted and adjusted odds ratios (OR) and 95% confidence intervals (CI) for potential correlates of low health literacy are shown in Table 3. In the adjusted analyses among patients, MMSE, education, and vision were significantly associated with the odds of having low health literacy. The adjusted odds ratios (low vs. adequate health literacy) were as follows: MMSE (OR = 0.68, CI [0.55, 0.83]), education category (OR = 0.15, CI [0.07, 0.31], and vision (OR = 1.04, CI [1.01, 1.07]). Higher MMSE score and education category were protective against low health literacy, whereas poorer vision was a risk factor for low health literacy. Each MMSE point increase was associated with 32% lower odds of low health literacy, while each increase in education stratum (indicating higher education) was associated with an 85% lower odds of low health literacy. Each decrease in visual acuity level (e.g., 20/30 vs. 20/20) was associated with 4% increased odds of low health literacy. Hispanic Elderly Patients and Their Caregivers Essay. Among caregivers, age, acculturation, MMSE, and recruitment site (clinic vs. senior center) were significantly associated with the odds of having low health literacy. The adjusted ORs (low vs. high health literacy) were as follows: age (OR = 3.16; CI [1.31, 7.25]), acculturation (OR = 0.45; CI [0.21, 0.93]), and MMSE (OR = 0.67; CI [0.54, 0.84]). After adjustment for all covariates in the model, recruitment site was not significantly associated with low health literacy. Older age was a risk factor for low health literacy, while higher MMSE scores and acculturation levels were protective against low health literacy. Each increase in age category was associated with greater than three times higher odds of low health literacy, while each increase in acculturation level was associated with 55% decreased odds of low health literacy; each point increase in MMSE was associated with 33% decreased odds of low health literacy. Hispanic Elderly Patients and Their Caregivers Essay.
