The aim of the current study is to provide comprehensive health care to older adults by assessing physical and mental health in a geriatric primary care setting, including evaluation of both subjective and functional health literacy. Health literacy is vital to understanding medical information and making subsequent decisions based on this information. Knowledge of patient health literacy may be particularly important for care providers, as it can provide guidance on how to best communicate with the patient (Nouri & Rudd, 2015). It may be particularly important to monitor health literacy within older adults, as several studies (e.g., Kobayashi et al., 2015) have shown that health literacy decreases with mild cognitive impairment. Approximately 250 patients (mean age = 76; 74% female; 16% African American) attending an interdisciplinary geriatrics clinic in West Alabama have been recruited to take part in a variety of behavioral health screenings. The current study assessed subjective health literacy using questions developed by Chew, Bradley, and Boyko (2004) and functional health literacy using the Newest Vital Sign (Weiss et al., 2005). While there was a significant correlation between subjective and functional health literacy (r = .43, p < .001), 81% of patients reported adequate subjective health literacy, while only 41% demonstrated adequate health literacy on a functional screening measure. Based on these findings, self-reported health literacy may not necessarily be reflective of performance on more functional measures. Given the potential consequences of overestimating health literacy, this represents a serious barrier to patient care.
Behavioral health screening by interprofessional teams practicing in outpatient geriatric primary care improves identification of patient cognitive functioning and emotional needs. On average, geriatrics clinic patients who consented to participate in research (N = 209; 74% women; 16.6% African American) were 76.7 years old. Patients had an average of 5.83 medical diagnoses. Only 26.2% of patients had scores indicating cognitive functioning within normal limits; 32.6% had scores indicative of mild neurocognitive disorder, and 41.2% had scores indicative of dementia at their baseline visit. Over 30% of patients reported clinically significant levels of depression or anxiety, and 16.5% of patients reported at least one indicator of hazardous alcohol use. Five-year longitudinal data analysis reveals multiple patient profiles. Behavioral health screening in primary geriatrics clinic care may help identify patient cognitive and emotional needs across time. Part of a symposium sponsored by the Mental Health Practice and Aging Interest Group.
This longitudinal behavioral health surveillance and integrated care project aims to assess physical and mental health and substance use in a geriatric primary care setting. Approximately 230 patients (mean age = 76; 74% female; 16% African American) attending an interdisciplinary geriatrics clinic in Alabama have taken part in baseline behavioral health screenings since 2014. Behavioral health measures include cognitive status, self-reported mood, subjective and objective health literacy, and alcohol use. All measures are administered by clinical psychology graduate students. Patients had an average of 5.83 medical diagnoses. Only 26.2% of patients had scores indicating cognitive functioning within normal limits; 32.6% had scores indicative of mild neurocognitive disorder, and 41.2% had scores indicative of dementia. Over 80% of patients had adequate self-reported health literacy; however, measurements of objective health literacy indicated a significant number of individuals have difficulty following medical directions independently. Over 30% of patients reported clinically significant levels of depression or anxiety, and 16.5% of patients reported at least one indicator of hazardous alcohol use. Specifically, 50.7% of patients consume alcohol on at least a yearly basis with 38.2% endorsing at least one problematic drinking behavior and 11.6% scoring in the clinically significant range for alcohol misuse. Moreover, 22.7% report use of opioid pain medication. The results of this study demonstrate that routine hazardous alcohol use screening as one component of integrated behavioral health care within geriatric primary care increases detection of hazardous alcohol use among older adults.
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