Barriers to Diabetes Care and Support (Cont'd)

Language and Literacy

It can be difficult to determine the specific reason for communication difficulties between a professional and an older person. Many elders have vision and hearing impairments. Still others may have cognitive impairment. Many who survived the Depression era may have had to quit school early to work, and never learned to read well.

Also, nearly half of your clients and patients may have an undiagnosed condition- one that prevents them from benefiting from the treatment plans and programs that you design. Over 90 million adults with low health literacy skills have limited ability to read and understand the instructions contained on prescriptions or medicine bottles, appointment slips, informed consent documents, insurance forms, and health educational materials.²⁰

Older adults may feel embarrassed or ashamed and may mask these problems. For example, an older woman who does not know how to read may say she forgot her reading glasses. Others may ask family members or caregivers to accompany them to a visit and act as a translator if needed.

For people with diabetes and other chronic diseases, low health literacy has been documented as resulting in poorer health outcomes.²¹ Studies have shown that older adults in managed care settings, especially those ages 85 and above, and older African Americans in hospital settings experience higher levels of low health literacy and literacy-related problems than other groups.²² Although these groups may experience the highest rates of literacy-related health problems, National Adult Literacy Survey data showed that between 71 and 85 percent of the nation's adults 65 and older have difficulty reading²³ and are therefore at risk for literacy-related health problems. The incidence of low health literacy increases with age, with the greatest burdens falling on those over 75.

Reading ability is measured by looking at three types of literacy: prose (understanding a newspaper article), document (reading a bus schedule), and quantitative (balancing a checkbook). It is difficult to know exactly why older adults scored worse than other age groups on the survey - it may be a combination of vision and comprehension issues.

²⁰ National Academy on an Aging Society. (2005) "Low Health Literacy Skills Increase Annual Health Care Expenditures by $73 Billion." Fact Sheet. Available at Aging Society on the World Wide Web: www.agingsociety.org/agingsociety/publications/fact/fact_low.html.

²¹ Schillinger, D., et al. (2002) "Association of Health Literacy with Diabetes Outcomes." Journal of the American Medical Association 288(4):475-482.

²² Dubow, J. (June 2004) "Adequate Literacy and Health Literacy: Prerequisites for Informed Health Care Decision Making." AARP Public Policy Institute Issue Brief IB70, p. 4.

²³ Sum, A., Kirsch, I., and Taggart, R. (February 2002) The Twin Challenges of Mediocrity and Inequality: Literacy in the U.S. from an International Perspective. Educational Testing Services, Statistics and Research Division; Center for Global Assessment.