Purpose: Many older adults have inadequate healthrelated literacy, which is associated with poor health outcomes. Thus, it is important to identify determinants of health literacy. We investigated relationships between health literacy and general cognitive and sensory abilities, as well as education, health, and demographic variables, in a community sample of middleaged and older adults. Design and Methods: Participants were 314 community-dwelling adults (67% female, 48% African American) diagnosed with chronic heart failure recruited for a pharmacist-based intervention study to improve adherence to chronic heart failure medications. We adminstered demographic, health, education, cognitive (e.g., processing speed, working memory), and sensory measures, and the Short Test of Functional Health Literacy in Adults (STOFHLA), as part of the baseline condition of this study. Results: STOFHLA scores were lower for participants who were older, less educated, male, African American, had more comorbidities, or scored lower on all cognitive ability measures. Hierarchical linear regression analyses showed that education and cognitive ability were independently associated with the STOFHLA measure and explained age differences in health literacy. Implications: The association of cognitive abilities and literacy has important implications for health literacy models and for interventions to reduce the impact of low health literacy on health outcomes. For example, medication instructions should be designed to reduce comprehension demands on general cognitive abilities as well as literacy skills.

We determined the factors associated with exacerbation of heart failure, using a cohort (n = 192) nested within a randomized trial at a university-affiliated ambulatory practice. Factors associated with emergency or hospital care included left ventricular ejection fraction, hematocrit and serum sodium levels, refill adherence, and the ability to read a prescription label. Refill adherence of <40% was associated with a threefold higher incidence of hospitalization for heart failure than a refill adherence of ≥80% (P = 0.002). In multivariable analysis, prescription label reading skills were associated with a lower incidence of heart failure-specific emergency care (incidence rate ratio, 0.76; 95% confidence interval (CI), 0.19-0.69), and participants with adequate health literacy had a lower risk of hospitalization for heart failure (incidence rate ratio, 0.34; 95% CI, 0.15-0.76). We conclude that inadequate treatment adherence and health literacy skills are key factors in the exacerbation of heart failure. These findings emphasize the need for careful instruction of patients about their medications.Patients with heart failure often require costly emergency or hospital care. In the United States, total annual annual health-care costs of the 5.3 million people with heart failure exceed $34.8 billion. 1 These costs derive largely from exacerbations requiring expensive emergency visits and hospitalizations. In 2004, heart failure was the second most expensive disease billed to Medicare, involving 5.8% of Medicare's total hospital expenditures. 2 In 2005, it accounted for 59.3% of estimated direct costs, largely from more than >1 million hospital admissions. 1 Studies of factors associated with clinical exacerbation requiring urgent care services, such as emergency department visits and hospitalizations, have primarily examined either Correspondence: MD Murray (mick@unc.edu). CONFLICT OF INTERESTThe authors declared no conflict of interest. NIH Public Access Author ManuscriptClin Pharmacol Ther. Author manuscript; available in PMC 2010 April 15. Published in final edited form as:Clin Pharmacol Ther. In addition, assessments of treatment adherence and health literacy skills are rarely considered in any analysis, even though these patient abilities are essential for effective self-management of chronic illness and are important for improved health outcomes. [11][12][13] Guided by a framework that links the health system and patient characteristics to self-care and health outcomes, 14 we measured a comprehensive set of variables in a cohort of 192 participants nested within a randomized controlled trial to ascertain patient characteristics and risk factors associated with clinical deterioration requiring emergency department visits or hospitalization. Variables included demographic classification, socioeconomic status, cardiac performance, functional status, results of laboratory tests, and treatments. We also measured treatment adherence and health literacy skills. We then simultaneously assessed the associatio...

We investigated how cognitive abilities and illness experience relate to illness knowledge. One hundred and forty-eight community-dwelling older adults including hypertensive patients and healthy adults completed a battery that measured illness knowledge, fluid cognitive abilities, crystallized abilities, and health history. Results suggested that hypertension knowledge was primarily associated with illness duration (despite a negative relationship between illness duration and fluid ability) and crystallized ability. Also, greater illness knowledge was associated with an illness perception that may be more consistent with self-care (e.g., greater sense of control). Implications for patient education and training are discussed.

The authors explored knowledge effects on comprehension of multimedia health information by older adults (age 60 or older). Participants viewed passages about hypertension, with text accompanied by relevant and irrelevant pictures, and then answered questions about the passage. Fixations on text and pictures were measured by eye-tracking. Participants with more knowledge of hypertension understood the passages better. This advantage was related to how they processed the passages: while knowledge differences were unrelated to overall time viewing displays, relationships between allocation and knowledge emerged when the data were partitioned into phases (during and after first reading the text). More knowledgeable participants spent relatively more time fixating text than pictures during the first pass. After this pass, they spent more time viewing the relevant picture rather than re-reading, with some evidence that this strategy was associated with comprehension. The findings have implications for designing multimedia education materials and analyzing eye-tracking measures during multimedia learning.

Interstitial nephritis was present in 13 of 25 adult beavers (Castor canadensis). Results of serum chemistry, serotyping, and culture for leptospires were compared with the extent of renal lesions. Although the pathogenesis of the nephritis was not determined, the survey provided baseline information on spontaneous renal disease in beavers.