Objective Studies show that the average person fails to understand and use health care related materials to their full potential. The goal of this study was to evaluate a health literacy instrument based on the Rapid Estimate of Adult Literacy in Medicine (REALM) that incorporates dental and medical terms into one 84-item Rapid Estimate of Adult Literacy in Medicine and Dentistry (REALM-D) measure and determine its association with patient characteristics of a culturally diverse dental clinic population. Methods An 84-item dental/medical health literacy word list and a 48-item health beliefs and attitudes survey was provided to a sample of 200 adult patients seeking treatment for the first time at an oral diagnosis clinic located in a large urban medical center in Los Angeles, California. Results Of the total sample, 154 participants read all of list 1 correctly, 141 read list 2 correctly, and only 38 read list 3 correctly. Nonwhite participants had significantly lower REALM-D scores at each level of difficulty as well as the total scale score compared to white participants. Participants who reported English as not their main language had significantly lower REALM-D scores. REALM-D scores also varied significantly by level of education among participants where as level of education increased, oral health literacy increased. At a bivariate level, race, education, and English as a main language remain predictive of health literacy in a regression model. An interaction between education and English as a main language was significant. Conclusions The REALM-D is an effective instrument for use by medical and dental clinicians in detecting differences among people of different backgrounds and for whom English was not their primary language.

Objectives The purpose of this study is to determine the association between personal characteristics, a person’s oral health literacy, and failing to show for dental appointments at a university dental clinic. Methods A secondary data analysis was conducted on data collected from 200 adults at a university dental clinic between January, 2005 and December, 2006. In the original study, an oral health literacy instrument, the Rapid Estimate of Adult Literacy in Medicine and Dentistry (REALM-D), was administered, sociodemographic and health information seeking behavior gathered, and electronic records reviewed. Results Descriptive and bivariate analyses, and a classification and regression tree (CART) analysis were conducted. Seeking health information through fewer sources versus multiple sources was the strongest predictor of failing to show. The subjects’ oral health literacy, as measured by the REALMD List 3 score was the next most significant variable. CART analyses also selected gender, chief complaint, age, and payment type as predictor variables. Conclusions Multiple factors contribute to failing to show for dental appointments. However, individuals who use fewer sources of oral health information, a subset of health literacy skills, are more likely to fail to show for dental appointments.

Objectives Few health literacy instruments are available to clinicians to help understand the implications of patient difficulty understanding health information. Those that do exist are lengthy and would not be conducive to use in a busy clinical setting. Long-term dental and medical outcomes may improve if health care providers can identify individuals with low health literacy levels who may benefit from tailored communication, yet few instruments are available for clinical use. The purpose of this study is to introduce a brief 20-item screener for limited dental/medical health literacy among adult dental patients. Methods Two-hundred adult patients seeking treatment at a dental clinic in a large medical complex completed a health literacy screening instrument and survey. Steps in the development of the 20-item instrument are described. Comparison of the 20-item dental/medical instrument with other health literacy measures are calculated using mean health literacy scores, tests of reliability and readability, and correlation coefficients. Results Scores on the brief 20-item measure varied significantly by race, education level, language use, needing help with medical/health materials forms. Those with lower dental/medical health literacy, as measured by the REALMD-20 were less likely to receive regular follow-up care than those with higher literacy. Conclusions The REALMD-20 is a quick screening instrument that can be used by clinicians to detect limited dental/medical health literacy among adult patients seeking treatment in dental/medical clinic settings.

Elder mistreatment is experienced by 10% of older adults and is much more common among older adults with dementia. It is associated with increased rates of psychological distress, hospitalization and death and, in the US, costs billions of dollars each year. Though elder mistreatment is relatively common and costly, it is estimated that less than 10% of instances of elder mistreatment are reported. Given these data, there is a great need for research on interventions to mitigate elder mistreatment, and a practical model or framework to use in approaching such interventions. While many theories have been proposed, adapted and applied to understand elder mistreatment, there has not been a simple, coherent framework of known risk factors of the victim, perpetrator, and environment that applies to all types of abuse. In this paper we present a new model to examine the multidimensional and complex relationships between risk factors. This model is informed by theories of elder mistreatment, research on risk factors for elder mistreatment and 10 years of experience of faculty and staff at an Elder Abuse Forensics Center who have investigated more than 1000 cases of elder mistreatment. We hope this model, the Abuse Intervention Model (AIM), will be used to study and intervene in elder mistreatment.

Purpose-While surgery related stress may interfere with the patient's ability to concentrate on instructions, language difficulty or low health literacy may also impede appropriate doctor/patient communication. The purpose of this study is to understand from a sample of minority patients the types of problems encountered during healing and the level of information regarding elements of postoperative instructions they recalled receiving at an inner-city safety net hospital. We initiated a qualitative study to understand the care sequence process and provision of informed consent and postoperative instruction. Methods-AfricanAmerican or Latino patients, 18 years of age or older, who had third molars removed under general anesthesia or received treatment for a mandibular fracture were recruited to participate in a focus group to discuss their treatment. Patients described their problem and any informed consent given about treatment risks and benefits and postoperative information they recalled.Results-A total of 137 former patients were approached, 57 agreed to participate (42%) and 34 of those (60%) completed the interview. Subjects included 14 females and 20 males. Five categories of patient problems were reported: physical, eating, treatment-related, psychosocial, and other problems. People reported 5 categories of coping strategies: medication use, physical treatments, dietary solutions, rest, and clinical assistance. Twenty people recalled being given The type and level of information that patients may require to make an informed decision in deciding specific treatment types is not well understood. Professional standards state that the health care provider must inform the patient about risks and benefits of each treatment. Nonetheless, the clinician struggles to succinctly and clearly present relevant information to a patient. 7Good communication is also critical in assisting patients to appropriately deal with postoperative management. Studies have shown that adequate postoperative education can improve patient satisfaction and reduce postsurgical morbidity. 8 Malins 5 pointed out that patients from ethnic minorities might need printed instructions in their native language and the services of an interpreter. Moreover, verbal or a combination of verbal and written instructions are preferred by most patients, particularly those with lower education. 3,4,6 However, without written reinforcement the understanding and retention of verbal instructions over a lengthy period of recovery cannot be assured.Alexander 3,9 stated that it is time for dental professionals, particularly those in the surgical specialties, to pay more attention to the phrasing, jargon, and terminology used in their postoperative instruction forms, as well as in their office brochures, informed consent forms, and the like. The purpose of this study was to elicit information from a minority sample about the types of problems encountered following oral surgery, the coping strategies they used to manage the problems, and the level of infor...

Objectives To introduce a multi-site assessment of oral health literacy and to describe preliminary analyses of the relationships between health literacy and selected oral health outcomes within the context of a comprehensive conceptual model. Methods Data for this analysis came from the Multi-Site Oral Health Literacy Research Study (MOHLRS), a federally-funded investigation of health literacy and oral health. MOHLRS consisted of a broad survey, including several health literacy assessments, and measures of attitudes, knowledge, and other factors. The survey was administered to 922 initial care-seeking adult patients presenting to university-based dental clinics in California and Maryland. For this descriptive analysis, confidence filling out forms, word recognition, and reading comprehension comprised the health literacy assessments. Dental visits, oral health functioning, and dental self-efficacy were the outcomes. Results Overall, up to 21% of participants reported having difficulties with practical health literacy tasks. After controlling for sociodemographic confounders, no health literacy assessment was associated with dental visits or dental caries self-efficacy. However, confidence filling out forms and word recognition were each associated with oral health functioning and periodontal disease self-efficacy. Conclusions Our analysis showed that dental school patients exhibit a range of health literacy abilities. It also revealed that the relationship between health literacy and oral health is not straightforward, depending on patient characteristics and the unique circumstances of the encounter. We anticipate future analyses of MOHLRS data will answer questions about the role that health literacy and various mediating factors play in explaining oral health disparities.

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OBJECTIVES To examine the relationship between individual characteristics and potential correlates of elder abuse in older adults who present with fractures. DESIGN Cross-sectional analysis of deidentified data extracted from medical records. SETTING Academic medical center. PARTICIPANTS Individuals aged 65 and with a primary diagnosis of any fracture admitted to an outpatient department or emergency department (ED) in a single southern California medical center over a 36-month period (N = 652). MEASUREMENTS Participant characteristics included demographic characteristics, number of medical visits, and point of service. Corresponding International Classification of Diseases, Ninth Revision (ICD-9) codes, E-codes, and V-codes were extracted to identify cause, location, and type of fracture. The presence of 13 potential correlates of abuse as captured by ICD-9 codes were extracted and summed. Descriptive statistics and regression models were used for analyses. RESULTS Mean age of participants was 77.2, 58% were female (58%), 60% were white (60%), and 46% had one or more potential correlates of abuse. In bivariate analyses, older age (≥80), dementia, seeking care in the ED (vs inpatient or outpatient clinics), only one visit to a medical facility (vs multiple visits) in the 36-month study period, cause of fracture as something other than a fall, and fractures of the head or face were more likely to have at least one correlate of abuse. In logistic regression, dementia (B = 0.794, standard error (SE) = 0.280); seeking care in the ED (vs outpatient or outpatient clinics) (B = 1.86, SE = 0.302); at least two visits to a medical facility (vs multiple visits) (B = 0.585, SE = 0.343); and fracture of the back (B = 0.730, SE = 0.289), head (B = 1.22, SE = 0.333), and face (B = 1.28, SE = 0.474) were associated with the presence of at least one correlate of abuse. CONCLUSION Certain characteristics in older adults with fracture are associated with potential correlates of abuse. Medical practitioners should have a heightened awareness when these signs are present. J Am Geriatr Soc 64:1651–1655, 2016.