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.