BACKGROUND: The factors influencing medication adherence have not been fully elucidated. Inadequate health literacy skills may impair comprehension of medical care instructions, and thereby reduce medication adherence. OBJECTIVES: To examine the relationship between health literacy and medication refill adherence among Medicare managed care enrollees with cardiovascular‐related conditions. RESEARCH DESIGN: Prospective cohort study. SUBJECTS: New Medicare enrollees from 4 managed care plans who completed an in‐person survey and were identified through administrative data as having coronary heart disease, hypertension, diabetes mellitus, and/or hyperlipidemia (n=1,549). MEASURES: Health literacy was determined using the short form of the Test of Functional Health Literacy in Adults (S‐TOFHLA). Prospective administrative data were used to calculate the cumulative medication gap (CMG), a valid measure of medication refill adherence, over a 1‐year period. Low adherence was defined as CMG≥20%. RESULTS: Overall, 40% of the enrollees had low refill adherence. Bivariate analyses indicated that health literacy, race/ethnicity, education, and regimen complexity were each related to medication refill adherence (P<.05). In unadjusted analysis, those with inadequate health literacy skills had increased odds (odds ratio [OR]=1.37, 95% confidence interval [CI]: 1.08 to 1.74) of low refill adherence compared with those with adequate health literacy skills. However, the OR for inadequate health literacy and low refill adherence was not statistically significant in multivariate analyses (OR=1.23, 95% CI: 0.92 to 1.64). CONCLUSIONS: The present study suggests, but did not conclusively demonstrate, that low health literacy predicts poor refill adherence. Given the prevalence of both conditions, future research should continue to examine this important potential association.

and visual impairment. Herein, we focus on the difficulties experienced by those who have acquired hearing and vision loss associated with age-related changes and pathologic conditions. Most individuals with age-related DSI experience gradual onset of mild to moderate sensorineural hearing loss and vision loss. Awareness of late-onset DSI among older individuals is increasing, presumably because the size of this population is growing rapidly. However, there is almost no research on rehabilitation for this population; therefore, there is a tremendous imperative to develop and test rehabilitation strategies.Although there are clear definitions of degrees of vision impairment and hearing impairment, definitions of DSI are lacking, and determination of a standardized definition is complex. Proposed definitions are functional in nature and tend to be nonspecific, with few implications for clinical practice. For instance, Davenport 5 suggests that DSI is "any combination of hearing and vision loss that interferes with access to communication and the environment and requires interventions beyond those necessary for hearing or vision loss alone." This generality is in part due to the fact that there is an unknown, and presumably variable, interaction between the two impairments. As D ual sensory impairment (DSI) refers to the presence of both hearing loss and vision loss. According to the Centers for Disease Control and Prevention, 1 at least 1.7 million people report DSI. Studies show that between 9% and 21% of adults older than 70 years have some degree of DSI [2][3][4] and that the prevalence increases with age. As pointed out by Desai et al, 1 as the population ages, so will the number of individuals with DSI.Individuals with DSI can be classified into the following 4 groups: congenital deafblindness, congenital visual impairment with acquired hearing impairment, congenital hearing impairment with acquired visual impairment, and acquired hearing Dual sensory impairment (DSI) refers to the presence of both hearing loss and vision loss. The occurrence of DSI is particularly prevalent among the aging population, with studies showing between 9% and 21% of adults older than 70 years having some degree of DSI. Despite this, there is little direction regarding recommended clinical practice and rehabilitation of individuals with DSI. It is assumed that the problems encountered by individuals with DSI are considerably greater than the effects of vision impairment or hearing impairment alone, because when these two sensory impairments are combined, the individual is seriously deprived of compensatory strategies that make use of the nonimpaired sense. In this article, the literature available regarding DSI is summarized, and research needs regarding rehabilitation strategies are outlined and discussed. Simple suggestions for addressing DSI are provided that use available tools and technology.

Two factors-participant characteristics and motor abilities-explained the majority of variance of walking under dual-task conditions; however, cognitive abilities also contributed significantly to the regression models. Rehabilitation focused on improving underlying balance and gait deficits, as well as specific cognitive impairments, may significantly improve walking under dual-task conditions.

Purpose To understand the factors that influence glaucoma treatment adherence with medication taking, prescription refills, and appointment keeping in order to develop an intervention for a specific population. Patients and Methods In-depth interviews were conducted with 80 individuals diagnosed with open angle glaucoma, glaucoma suspect, or ocular hypertension. Additional eligibility requirements were that all participants were: between the ages of 18–80; White or African American; spoke and understood English; and were taking daily doses of topical glaucoma treatments for at least the past year. Cross-tabulations and Chi-square tests were conducted to compare adherent and non-adherent individuals, classified as such based on self-report and medical chart/pharmacy data. Results Compared to adherent participants, non-adherent participants were less likely to: believe their eye doctors spent sufficient time with them; ask their eye doctor if they had any questions; know of benefits to taking their glaucoma medication regularly; and have someone help them take their glaucoma medications or drive them to eye appointments. Conversely, compared to adherent individuals, non-adherent participants were more likely to have difficulty remembering to take their medications and to believe their glaucoma would affect their eye sight in the future. Conclusions Non-adherent glaucoma patients struggle with a variety of issues related to consistent use of glaucoma medicine and routine eye care. Interventions are needed to address these modifiable factors related to glaucoma treatment adherence.

Among older veterans with moderate-to-severe CKD, multimorbidity presents a major challenge for CKD self-management. Because virtually all older adults with CKD have multimorbidity, an integrated treatment approach that supports self-management across commonly occurring conditions may be necessary to meet the needs of these patients.

Thirty hours of adapted tango lessons improved balance, mobility, endurance, and dual-task ability in a participant with chronic stroke. The participant enjoyed the classes, was adherent, and wished to continue. This is the first reported use of adapted tango dance as rehabilitation for an individual with chronic stroke and low vision.

BACKGROUND: Health care providers often counsel prostate cancer patients about treatment options with medical terminology. However, studies have demonstrated a severe lack of comprehension of these terms, particularly in underserved populations. It was hypothesized that a video-based educational tool would significantly improve the understanding of key terms related to prostate health in a predominantly lower literacy population. METHODS: A software application was developed by various experts, including urologists and human-computer interaction specialists, to serve as a video-based educational tool emphasizing narrated animations to promote understanding of terms related to urinary, bowel, and sexual function. This application was viewed by patients recruited from 2 low-income safety net clinics, where a previously developed survey was administered to assess pre-and postintervention levels of comprehension. RESULTS: Fifty-six patients with a mean literacy level of 7th to 8th grade completed the study. Patients achieved statistically significant improvements in comprehension for the majority of the terms after the video intervention, with notable improvements including the terms incontinence (from 14% to 50%), bowels (from 14% to 46%), and impotence (from 58% to 84%). Patients demonstrated significant gains in their understanding of the function of the prostate (from 11% to 30%) and in their ability to locate the prostate on anatomic drawings (from 50% to 82%). CONCLUSIONS: This video-based educational tool is an effective method for overcoming the severe lack of comprehension of prostate health terminology among patients. The improvements achieved have the potential to enhance patient participation in shared and informed decision making and to support combined visual-audio multimedia as a promising tool for prostate cancer education. Cancer 2015;121:733-40.

The presence of one or more discordant/unrelated conditions was associated with increased risk for adverse health outcomes, beyond the effect of multimorbidity.