Health literacy among Medicare enrollees in a managed care organization

Context Elderly patients may have limited ability to read and comprehend me dical information pertinent to their health, Objective To determine the prevalence of low functional health literacy amo ng community-dwelling Medicare enrollees in a national managed care organiz ation. Design Cross-sectional survey. Setting Four Prudential HealthCare plans (Cleveland, Ohio; Houston, Tex; so uth Florida; Tampa, Fla). Participants A total of 3260 new Medicare enrollees aged 65 years or older were interviewed in person between June and December 1997 (853 in Cleveland , 498 in Houston, 975 in south Florida, 934 in Tampa); 2956 spoke English a nd 304 spoke Spanish as their native language. Main Outcome Measure Functional health literacy as measured by the Short Te st of Functional Health Literacy in Adults. Results Overall, 33.9% of English-speaking and 53.9% of Spanish-speaking re spondents had inadequate or marginal health literacy. The prevalence of ina dequate or marginal functional health literacy among English speakers range d from 26.8% to 44.0%. In multivariate analysis, study location, race/langu age, age, years of school completed, occupation, and cognitive impairment w ere significantly associated with inadequate or marginal literacy. Reading ability declined dramatically with age, even after adjusting for years of s chool completed and cognitive impairment, The adjusted odds ratio for havin g inadequate or marginal health literacy was 8.62 (95% confidence interval, 5.55-13.38) for enrollees aged 85 years or older compared with individuals aged 65 to 69 years. Conclusions Elderly managed care enrollees may not have the literacy skills necessary to function adequately in the health care environment. Low healt h literacy may impair elderly patients' understanding of health messages an d limit their ability to care for their medical problems.