[The association of limited health literacy and risk of arterial stiffness in community-dwelling older adults]

Effect of high health literacy and the frequency of social activities on preventing disability

OBJECTIVE

This longitudinal study aimed to identify the impact of high health literacy (HL) and participation in more social activities (SA) on preventing the risk of disability among community-dwelling older adults.

METHODS

Participants were 3,486 community-dwelling older adults who underwent functional health examinations. Participants were classified into four groups based on High (Low) HL and High (Low) SA. A Cox proportional hazards model was used to assess the risk of disability over five years among the four groups.

RESULTS

During follow-up, 339 patients with disabilities were observed. In the Cox proportional hazards analysis, only High HL and High SA groups were significantly associated with a lower hazard ratio (HR) for disability onset (HR = 0.71, 95% confidence interval = 0.51-0.99).

CONCLUSIONS

In community-dwelling older adults, high HL and increased SA effectively reduced the risk of disability compared to low HL and low SA.

The longitudinal Relationship between Educational Level and Arterial Stiffness: The Toon Health Study

AIM

Previous studies have shown that higher educational levels are associated with slower progression of arterial stiffness; however, evidence from Asian countries is lacking. We aimed to examine the association between educational level and arterial stiffness measured using the cardio-ankle vascular index (CAVI) over time in a sample of Japanese men and women.

METHODS

A total of 1381 participants (453 men and 928 women) were included in the present study. Arterial stiffness was measured using the CAVI at baseline (2009-2012) and 5 years later (2014-2018). The educational level was divided into two groups (junior or senior high school vs. junior college, professional school, college, or higher) based on a self-administered questionnaire. A mixed-effects model was used to analyze the association between education and the CAVI at baseline and its change over 5 years. The participants were stratified by sex and age (＜65 vs. ≥ 65 years).

RESULTS

The CAVI at baseline did not differ significantly according to education in any of the four subgroups accorded to age and sex. However, among women of ≥ 65 years of age, the change in the CAVI over 5 years was significantly smaller in the higher education group (p=0.04). No such association was found in women of ＜65 years of age or men.

CONCLUSIONS

Education is a factor that affects arterial stiffness in women of ≥ 65 years of age. These results suggest that educational level affects arterial stiffness, depending on sex and age.

Associations between health literacy and information-evaluation and decision-making skills in Japanese adults

Background

Health literacy among Japanese is often low, making it difficult for them to evaluate health information and make informed decisions. However, the health literacy scales applied measure the perceived difficulty of health-related tasks; they do not directly assess the specific skills needed to perform the tasks: the skills to judge the reliability of diverse information using evaluation criteria and implement rational decision-making. Therefore, the study objectives were to investigate the following issues using a nationwide survey in Japan. (1) When obtaining information, to what extent do people apply criteria for evaluating information to confirm its reliability; when making decisions, to what extent do they seek out available options and compare pros and cons based on their own values? (2) How strongly are such skills associated with health literacy and demographic characteristics? (3) What opportunities are available to learn these skills?

Methods

We conducted an online questionnaire survey using a Japanese Internet research company; 3,914 valid responses were received. The measures comprised health literacy (European Health Literacy Survey Questionnaire), five items on information evaluation, four items on decision-making, and items on the availability and location of learning opportunities. We calculated Pearson correlations to explore the association of health literacy with information-evaluation and decision-making skills. Multivariate analyses were also conducted using these factors as dependent variables.

Results

Fewer than half (30%–50%) of respondents reported always or often evaluating information and engaging in decision-making. Health literacy was significantly and positively correlated with the specific skills of information evaluation and decision-making (r = .26 and .30, respectively) as were multivariate analyses (beta = .15 and .22, respectively).

Over 40% of respondents had never learned those skills. The most common resources for learning the skills were the Internet and television; less-used resources were schools and workplaces.

Conclusions

Both information-evaluation and decision-making skills were associated with health literacy. However, these skills are not sufficiently widespread in Japan because there are few opportunities to acquire them. More research is needed to raise awareness of the importance of such skills for improving health literacy and providing learning opportunities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13892-5.

The Effectiveness of an Active Learning Program in Promoting a Healthy Lifestyle among Older Adults with Low Health Literacy: A Randomized Controlled Trial

BACKGROUND

Older adults often have a greater need for health information and health care services because access to these helps them manage their health and the chronic conditions of aging. Therefore, low health literacy bears a special significance for the population of older adults.

OBJECTIVES

The aim of this study was to examine the effects of an active learning program on health literacy, lifestyle behaviors, physical function, and mental health among community-dwelling older adults with low health literacy.

METHODS

This single-blind, randomized controlled trial involved 60 participants aged ≥65 years with a low health literacy who were randomly assigned to an intervention (n = 30) or control (n = 30) group. Across 24 weeks, the intervention group attended weekly 90-min active learning program sessions, which involved exploratory learning, group work, and the self-planning of behavior changes that promote a healthy lifestyle. The control group attended a 90-min class, which was taught in accordance with the didactic teaching method. For both groups, the programs focused on the role of exercise, diet/nutrition, and cognitive activity for promoting health among older adults. The outcome measures were administered at baseline and week 24. Comprehensive health literacy (i.e., primary outcome) was assessed using the Health Literacy Scale-14. Lifestyle factors (i.e., physical activity, dietary variety, life-space mobility, and social network size), physical function, and depressive symptoms were measured. We used a linear mixed model to estimate the intervention effects in accordance with the intention-to-treat approach.

RESULTS

When compared to the control group, the intervention group demonstrated a significant improvement in communicative health literacy, step count, engagement in moderate-to-vigorous physical activity, dietary variety, life-space mobility, social network size, grip strength, gait speed, and depressive symptoms.

CONCLUSIONS

The active learning program can promote a healthy lifestyle and prevent functional decline among older adults who lack the confidence to engage in health communication.

Effects of Active Learning Education on Arterial Stiffness of Older Adults with Low Health Literacy: A Randomized Controlled Trial

Aim: We examined the effects of active learning education on arterial stiffness and physical activity of community-dwelling older adults with low health literacy.

Methods: This study is a secondary analysis of randomized controlled trial of 60 participants aged 65 and older with low health literacy. The intervention group ( n =30) participated in a weekly 90-minute active learning program session for 24 weeks, which addressed health promotion in older age. The control group ( n =30) attended a 90-minute health education class in a didactic manner. The outcomes were measured at baseline and in week 24. The degree of arterial stiffness was assessed based on the cardio-ankle vascular index (CAVI) using the VS-1500 device (Fukuda Denshi Co., Ltd., Tokyo, Japan). The shortened version of the self-reported International Physical Activity Questionnaire was used to assess the amount of total physical activity determined by the metabolic equivalent hours per week. We used analysis by intention-to-treat, with multiple imputation for missing data.

Results: Seven participants (11.7%) dropped out prior to the post-intervention assessment. The multiple imputation analysis revealed that the intervention group showed significant improvement in CAVI [between-groups difference (95% confidence interval)=-0.78 (-1.25 to -0.31), Cohen’s d =0.82] and physical activity [32.5 (0.3 to 64.7), Cohen’s d =0.57] as compared with the control group. The sensitivity analysis for the complete cases showed similar results.

Conclusion: Active learning health education may be effective in improving arterial stiffness and physical activity in older adults with low health literacy.