Older adults can maintain a good understanding of health if they regularly use the Internet and take part in social events, new research suggests.
Information on health and disease is now widely available, and people expect to be participants in the process of diagnosis and treatment. But age-related changes in the brain risk compromising the ability of older people to utilize the health care system, warn Professor Jane Wardle of University College London, U.K., and colleagues.
They add that, during aging, adults often have increased contact with the health care system as the risk for several chronic diseases increases.
But age-related cognitive changes may “compromise the ability to navigate the health care system and use health information,” they state in the Journal of Epidemiology & Community Health. This is linked to poorer self-care, especially regarding long-term conditions, a higher chance of needing emergency care services, less preventive care, and a higher mortality risk.
Health literacy can be defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions,” say the researchers.
They investigated whether health literacy during aging can be influenced by technological and social factors. Information was taken on 4,368 men and women aged 52 years or older from 2004-2005 and 2010-2011. All were taking part in the long-term English Longitudinal Study of Ageing.
Health literacy was measured at baseline using a reading comprehension test of a medicine label. Initially, the rate of adequate health literacy was high, at 73 percent, but by the end of followup, this had fallen by 19 percent.
About 32 percent of the participants undertook “consistent Internet use,” and these individuals appeared to be significantly protected against health literacy decline, having a 23 percent lower risk of health literacy decline than the 40 percent who never used the Internet or email.
The same was seen for “consistent engagement in cultural activities” such as visiting the cinema, art galleries, museums, and the theatre. About 39 percent took part in these activities, and this group was at a 27 percent lower risk of health literacy decline. The number of such activities was directly linked to maintenance of health literacy.
Those who took part in both categories of activity were at a 49 percent lower risk of health literacy decline than those who took part in none. This benefit on health literacy was independent of cognitive function and decline, assessed by face-to-face interview and several reliable tests.
The authors caution that this observational study cannot determine cause and effect, but add, “The results indicate that health literacy skills are fluid over time, that loss of literacy skills during aging is not inevitable, and that technological and social factors should be understood as influences on literacy skills.”
“Support for older adults to maintain socially engaged lives and to access the Internet should help promote the maintenance of functional literacy skills during aging,” they state.
They add that declining health literacy was also linked to poorer brain function scores at the start of the study, being non-white, having relatively low wealth, few educational qualifications, and difficulties carrying out routine daily activities.
However, while these demographic factors are either not or not easily modifiable, low health literacy is modifiable. It “represents a route to improvement of health in the population that must not be missed by policymakers and the health system,” say the experts.
Previous long-term research studies have indicated that a diverse range of social activities including physical activity, intellectual game-playing, membership of religious and other social groups, and participation in cultural activities can all protect against age-related cognitive decline.
There appears to be no evidence, however, that a short period of socially and cognitively stimulating activities that do not include active learning of novel skills brings cognitive benefits.
“This body of knowledge is still evolving,” Professor Wardle believes, “although it appears that cognitively-stimulating social activities may help maintain cognitive function during ageing. This relationship may extend to health literacy.
“Our study highlights the usefulness of putting health literacy in the context of both cognitive and social functions, particularly when trying to better understand changes to health literacy skills in later life.”
She calls for further studies that include additional cognitive, technological, and social measurements.
Kobayashi, L. C. et al. Internet use, social engagement and health literacy decline during ageing in a longitudinal cohort of older English adults. Journal of Epidemiology and Community Health. 26 November 2014 doi: 10.1136/jech-2014-204733