Background Health literacy (the capacity to process and understand basic health information) is essential to health management, although health literacy skills decline with age. Whether cognitively stimulating behavioural practices can help older adults maintain health literacy skills is unknown. We investigated whether reading a daily newspaper, using the internet, and maintaining social attachments protect against decline in health literacy skills during ageing, independent of cognitive ageing.
Methods We used data from 4439 participants aged ≥52 years in the English Longitudinal Study of Ageing (ELSA) from 2004–11. The ELSA is based on random stratified sampling of private English households and data are collected biennially through in-person interviews, nurse visits, and self-completion questionnaires. Health literacy was measured at baseline (2004–5) and follow-up (2010–11) in the study interview using a reading comprehension test of a fictitious medicine label. Newspaper reading, internet use, and social attachment were assessed in the self-completion questionnaire every two years from baseline to follow-up. The influence of consistently reading a daily newspaper (vs. never reading), consistently using the internet (vs. never using), and of consistent social attachment (vs. consistent detachment) in civic participation, leisure activities, cultural engagement, and social networks over the six-year follow-up on health literacy decline were estimated using multivariable-adjusted logistic regression (StataSE 13.0). Baseline age, ethnicity, education, cognitive function, cognitive decline, and all main effects were included in the fully-adjusted model.
Results In the fully-adjusted model, consistent internet use (1427/4439; 32%) was protective against health literacy decline (OR=0.75, 95% CI 0.59–0.95). Consistent cultural engagement (1766/4439; 40%) was also protective against health literacy decline (OR=0.70, 95% CI 0.55–0.89). Consistently reading a daily newspaper (1963/4439; 44%) was not associated with health literacy decline (fully-adjusted OR=1.04, 95% CI 0.84–1.29). Consistent attachment in civic participation (1576/4439; 36%), leisure activities (1401/4439; 32%), and social networks (3341/4439; 75%) were not associated with health literacy decline in the fully-adjusted model.
Conclusion Internet use and cultural engagement, including attending the cinema, art galleries, museums, or the theatre, appear to help older adults to maintain health literacy skills during ageing regardless of cognitive functioning. Reading a daily newspaper had no association with health literacy decline; future research should consider reading frequency and other types of media and literature. Importantly, older adults frequently did not use the internet. Support for older adults to maintain active social lives and access the internet should help improve health and well-being through promotion of health literacy skills.
- health literacy
- internet use