Skip to main content

Advertisement

SpringerLink
Log in

Cognition and Health Literacy in Patients with Hypertension

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

BACKGROUND

Approximately half of the US population has marginal or inadequate health literacy, a measure highly associated with health outcomes. This measure is often linked to age and education, but recent evidence from patients with chronic heart failure suggests that much of age-related variability in health literacy can be explained by cognitive abilities (e.g., working memory, processing speed).

OBJECTIVE

We examined the role of cognitive and sensory abilities as mediators of age and education in determining functional health literacy among patients with hypertension.

PARTICIPANTS

Four hundred ninety two community-dwelling adults diagnosed with hypertension (aged 21 to 92 years) participated. They were primarily female (73%), African-American (68%), and reported taking on average 7.8 prescribed medications.

MEASUREMENTS

Before participation in a medication adherence intervention study, participants completed a battery of health literacy-related tasks. They completed tests that measured health literacy [Short Test of Functional Health Literacy in Adults (STOFHLA)], cognitive abilities (working memory, processing speed), sensory abilities (visual acuity and hearing), and physical health.

RESULTS

Regression analyses showed that health literacy was related to age, education, and race (accounting for 24.4% of variance in STOFHLA scores). Cognitive ability accounted for an additional 24% of variance and greatly reduced the influence of age, education, and race (by 75%, 40%, and 48%, respectively).

CONCLUSIONS

When controlling for cognitive and sensory variables, the association of age and education with STOFHLA scores was dramatically reduced. Thus, future interventions aimed at improving self-care for patients with low health literacy should aim to reduce demands on patients’ cognitive abilities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of America’s Adults: Results From the 2003 National Assessment of Adult Literacy, NCES 2006-483. Washington, DC: U.S. Department of Education; 2006.

    Google Scholar 

  2. Kutner M, Greenberg E, Baer J. A First Look at the Literacy of America's Adults in the 21st Century. Washington, DC: National Center for Education Statistics; 2005.

    Google Scholar 

  3. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. Health literacy: Report on the Council on Scientific Affairs. JAMA. 1999;281:551–7.

    Article  Google Scholar 

  4. Andrus MR, Roth MT. Health literacy: A review. Pharmacotherapy. 2002;22:282–302.

    Article  PubMed  Google Scholar 

  5. DeWalt DA, Berkman ND, Sheridan S, Lohr KN, Pignone MP. Literacy and health outcomes: A systematic review of the literature. J Gen Intern Med. 2004;19:1228–39.

    Article  PubMed  Google Scholar 

  6. Nielsen-Bohlman L, Panzer AM, Kindig DA. Health literacy: A prescription to end confusion. Washington, DC: National Academies Press; 2004.

    Google Scholar 

  7. Baker DW, Williams MV, Parker RM, Gazmararian JA, Nurss J. Development of a brief test to measure functional health literacy. Patient Educ Couns. 1999;38:33–42.

    Article  PubMed  CAS  Google Scholar 

  8. Paasche-Orlow MK, Parker RM, Gazmararian JA, Nielsen-Bohlman LT, Rudd RR. The prevalence of limited health literacy. J Gen Intern Med. 2005;20:1–10.

    Article  Google Scholar 

  9. Kintsch W. Comprehension: A paradigm for cognition. New York: Cambridge University Press; 1998.

    Google Scholar 

  10. Wingfield A, Stine-Morrow EAL. Language and speechIn: Craik FIM, Salthouse TA, eds. The Handbook of Aging and Cognition. Mahwah, NJ: Erlbaum; 2000:359–416.

    Google Scholar 

  11. Morrow DG, Clark D, Tu W, et al. Correlates of health literacy in patients with chronic heart failure. Gerontologist. 2006;46(5):669–76.

    PubMed  Google Scholar 

  12. Echt KV, Schuchard RA. The role of vision and cognition in older adults’ low health literacy. Paper presented at the 10th Cognitive Aging Conference, Atlanta, GA; 2004.

  13. American Heart Association. Heart disease and stroke statistics—2006 Update. Dallas, TX: American Heart Association; 2006.

    Google Scholar 

  14. Chalmers J, Chapman J. Challenges for the prevention of primary and secondary stroke: the importance of lowering blood pressure and total cardiovascular risk. Blood Press. 2001;13:829–32.

    Google Scholar 

  15. Gazmararian JA, Williams MV, Peel J, Baker DW. Health literacy and knowledge of chronic illness. Patient Educ Couns. 2003;51:267–75.

    Article  PubMed  Google Scholar 

  16. Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patients’ knowledge of their chronic disease: A study of patients with hypertension and diabetes. Arch Int Med. 1998;158:166–72.

    Article  CAS  Google Scholar 

  17. Baker DW, Parker RM, Williams MV, Clark WS, Nurss J. The relationship of patient reading ability to self-reported health and use of health services. Am J Public Health. 1997;87:1027–30.

    PubMed  CAS  Google Scholar 

  18. Murray MD, Young J, Morrow DG, et al. Methodology of an ongoing, randomized, controlled trial to improve drug use for elderly patients with chronic heart failure. Am J Geriatr Pharmacother. 2004;2:53–65.

    Article  PubMed  Google Scholar 

  19. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206–52.

    Article  PubMed  CAS  Google Scholar 

  20. Charlson ME, Pompei P, Alex KL, MacKensie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40:373–83.

    Article  PubMed  CAS  Google Scholar 

  21. Swan GE, Carmell D, Larue A. Systolic blood pressure tracking over 25 to 30 years and cognitive performance in older adults. Stroke. 1998;29(11):2334–40.

    PubMed  CAS  Google Scholar 

  22. Baker DW, Gazmararian JA, Sudano J, Patterson M. The association between age and health literacy among elderly persons. J Gerontol B Psychol Sci Soc Sci. 2000;55B:S368–74.

    Google Scholar 

  23. Bayles KA, Tomoeda CK. Arizona Battery for Communication Disorders of Dementia. Tucson, AZ: Canyonlands; 1993.

    Google Scholar 

  24. Salthouse TA, Babcock RL. Computational and Listening Span. Atlanta: Georgia Institute of Technology; 1990.

    Google Scholar 

  25. Salthouse TA. Mediation of adult age differences in cognition by reductions in working memory and speed of processing. Psychol Sci. 1991;2:179–83.

    Article  Google Scholar 

  26. Park DC, Smith AD, Lautenschlager G, et al. Mediators of long-term memory performance across the life span. Psychol Aging. 1996;11:621–37.

    Article  PubMed  CAS  Google Scholar 

  27. Gazmararian JA, Baker DW, Williams MV, et al. Health literacy among Medicare enrollees in a managed care organization. JAMA. 1999;281:545–51.

    Article  PubMed  CAS  Google Scholar 

  28. Manly JJ, Jacobs DM, Touradji P, Small SA, Stern Y. Reading level attenuates differences in neuropsychological test performance between African American and White elders. J Int Neuropsychol Soc. 2002;8:341–8.

    Article  PubMed  Google Scholar 

  29. Kilander L, Nyman H, Boberg M, Hansson L, Lithell H. Hypertension is related to cognitive impairment: a 20-year follow-up of 999 men. Hypertension. 1998;31:780–6.

    PubMed  CAS  Google Scholar 

  30. Tzourio C, Dufouil C, Ducimetiere P, Alperovitch A. Cognitive decline in individuals with high blood pressure. Neurology. 1999;53:1948.

    PubMed  CAS  Google Scholar 

  31. Zuccala G, Pedone C, Cesari M, et al. The effects of cognitive impairment on mortality among hospitalized patients with heart failure. Am J Med. 2003;115:97–103.

    Article  PubMed  Google Scholar 

  32. Murray MD, Wu J, Tu W, et al. Health literacy predicts medication adherence. Clinical Pharmacology & Therapeutics, 75, P76. Paper presented at the 2004 Annual Meeting of the American Society for Clinical Pharmacology & Therapeutics, Miami Beach; 2004

  33. Murray MD, Young J, Hoke S, et al. Pharmacist intervention to improve medication adherence in heart failure: a randomized trial. Ann Intern Med. 2007;146(10):714–25.

    PubMed  Google Scholar 

Download references

ACKNOWLEDGMENTS

Research support from National Institutes of Health (NIH) grants R01 HL69399 and 5K23AG020088-02. Any opinions, findings, and conclusions or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the NIH.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Beckman Institute of Advanced Science and Technology and the Institute of Aviation, University of Illinois at Urbana-Champaign, Urbana, IL, USA

    Brian R. Levinthal MA & Daniel G. Morrow PhD

  2. Indiana University School of Medicine, Indianapolis, IN, USA

    Wanzhu Tu PhD

  3. Regenstrief Institute, Inc., Indianapolis, IN, USA

    Wanzhu Tu PhD

  4. Indiana University Center for Aging Research, Indianapolis, IN, USA

    Wanzhu Tu PhD

  5. University School of Medicine, Indianapolis, IN, USA

    Jingwei Wu MS

  6. Pharmaceutical Policy and Evaluative Sciences Division, Center for Excellence in Pharmaceutical Outcomes Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Michael D. Murray PharmD

Authors
  1. Brian R. Levinthal MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel G. Morrow PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wanzhu Tu PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jingwei Wu MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael D. Murray PharmD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel G. Morrow PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Levinthal, B.R., Morrow, D.G., Tu, W. et al. Cognition and Health Literacy in Patients with Hypertension. J GEN INTERN MED 23, 1172–1176 (2008). https://doi.org/10.1007/s11606-008-0612-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-008-0612-2

KEY WORDS

Search

Navigation