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Aging Clinical and Experimental Research

, Volume 31, Issue 12, pp 1827–1832 | Cite as

The association of health literacy, numeracy and graph literacy with frailty

  • Aakashi Shah
  • Juliana Ferri-Guerra
  • Mohammed Y. Nadeem
  • Douglas Salguero
  • Raquel Aparicio-Ugarriza
  • Marianne Desir
  • Jorge G. RuizEmail author
Original Article

Abstract

Background

Frailty is a state of vulnerability to stressors which may result in high mortality, morbidity, and health-care utilization in older adults. Whether health literacy, graph literacy and numeracy are associated with frailty is unknown.

Aim

To assess the association of health literacy, numeracy and graph literacy with frailty in male veterans.

Methods

This is a retrospective study of 470 cognitively intact, non-depressed veterans who completed evaluations of health literacy, numeracy and graph literacy at Miami VA facility in 2012. A 43-item frailty index was created as a proportion of all potential variables (demographics, comorbidities, number of medications, laboratory tests, and activities of daily life). Odds ratios and 95% confidence intervals were calculated by multinomial logistic regression models with frailty status (robust, prefrail and frail) as the outcome variable, and with health literacy, numeracy, and graph literacy scores as independent variables. Age, race, ethnicity, education, socio-economic status, and comorbidities were considered as covariates.

Results

Patients were 100% male, 40% White, 82% non-Hispanic, mean age was 56.8 years. The proportion of robust, pre-frail and frail was 10.0%, 61.3% and 28.7%, respectively. Neither health literacy nor objective nor subjective numeracy was associated with frailty after adjustment for covariates. In contrast, higher graph literacy scores were associated with a lower risk for frailty (p = .015) even after adjusting known risk factors for frailty.

Discussion and conclusion

Neither health literacy nor numeracy is associated with frailty. Higher graph literacy score is associated with a lower risk for frailty even after adjusting for known risk factors for frailty.

Keywords

Frailty Health literacy Numeracy Graph literacy Veterans 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

We obtained approval from our IRB as a quality improvement project exempted from informed consent to conduct a retrospective electronic health record review.

Supplementary material

40520_2019_1182_MOESM1_ESM.docx (18 kb)
Supplementary material 1 (DOCX 18 kb)

References

  1. 1.
    Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156CrossRefGoogle Scholar
  2. 2.
    Orkaby AR, Nussbaum L, Ho YL et al (2018) The burden of frailty among US veterans and its association with mortality, 2002–2012. J Gerontol A Biol Sci Med Sci.  https://doi.org/10.1093/gerona/gly232 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Feng Z, Lugtenberg M, Franse C, Fang X et al (2017) Risk factors and protective factors associated with incident or increase of frailty among community-dwelling older adults: a systematic review of longitudinal studies. PLoS One 12:e0178383.  https://doi.org/10.1371/journal.pone.0178383 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Nielsen-Bohlman L, Panzer AM, Kindig DA (2004) Health literacy: a prescription to end confusion. National Academies Press US, WashingtonGoogle Scholar
  5. 5.
    Pleasant A, Rudd RE, O’Leary C, et al (2016) Considerations for a new definition of health literacy: National Academy of Medicine Washington, DC. https://nam.edu/wp-content/uploads/2016/04/Considerations-for-a-New-Definition-of-Health-Literacy.pdf. Accessed 10 January 2019
  6. 6.
    Peters E (2012) Beyond comprehension: the role of numeracy in judgements and decisions. Curr Dir Psychol Sci 21:31–35.  https://doi.org/10.1177/093721411429960 CrossRefGoogle Scholar
  7. 7.
    Galesic M, Garcia-Retamero R (2011) Graph literacy: a cross-cultural comparison. Med Decis Mak 31:444–457.  https://doi.org/10.1177/0272989X10373805 CrossRefGoogle Scholar
  8. 8.
    Berkman ND, Sheridan SL, Donahue KE et al (2011) Low health literacy and health outcomes: an updated systematic review. Ann Intern Med 155:97–107.  https://doi.org/10.7326/0003-4816-155-2-201107190-00005 CrossRefPubMedGoogle Scholar
  9. 9.
    Rodriguez V, Andrade AD, Garcia-Retamero R et al (2013) Health literacy, numeracy, and graphical literacy among veterans in primary care and their effect on shared decision making and trust in physicians. J Health Commun. 18(Suppl 1):273–289.  https://doi.org/10.1080/10810730.2013.829137 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Huang CH, Lai YC, Lee YC et al (2018) Impact of health literacy on frailty among community-dwelling seniors. J Clin Med. 7:481.  https://doi.org/10.3390/jcm7120481 CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Shirooka H, Nishiguchi S, Fukutani N et al (2017) Association between comprehensive health literacy and frailty level in community-dwelling older adults: a cross-sectional study in Japan. Geriatr Gerontol Int. 17:804–809.  https://doi.org/10.1111/ggi.12793 CrossRefPubMedGoogle Scholar
  12. 12.
    Weiss BD (2005) Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 3:514–522.  https://doi.org/10.1370/afm.405 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Schwartz LM, Woloshin S, Black WC et al (1997) The role of numeracy in understanding the benefit of screening mammography. Ann Intern Med 127:966–972.  https://doi.org/10.7326/0003-4819-127-11-199712010-00003 CrossRefPubMedGoogle Scholar
  14. 14.
    Lipkus IM, Samsa G, Rimer BK (2001) General performance on a numeracy scale among highly educated samples. Med Decis Mak 21:37–44.  https://doi.org/10.1177/0272989X0102100105 CrossRefGoogle Scholar
  15. 15.
    Cokely ET, Galesic M, Schulz E et al (2012) Measuring risk literacy: the Berlin numeracy test. Judgm Decis Mak. 7:25–47Google Scholar
  16. 16.
    Fagerlin A, Zikmund-Fisher BJ, Ubel PA et al (2007) Measuring numeracy without a math test: development of the subjective numeracy scale. Med Decis Mak 27:672–680.  https://doi.org/10.1177/0272989X07304449 CrossRefGoogle Scholar
  17. 17.
    Searle SD, Mitnitski A, Gahbauer EA et al (2008) A standard procedure for creating a frailty index. BMC Geriatr 8:24.  https://doi.org/10.1186/1471-2318-8-24 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Espinoza SE, Hazuda HP (2008) Frailty in older Mexican-American and European-American adults: is there an ethnic disparity? J Am Geriatr Soc 56:1744–1749.  https://doi.org/10.1111/j.1532-5415.2008.01845.x CrossRefPubMedGoogle Scholar
  19. 19.
    Vetrano DL, Palmer K, Marengoni A et al (2018) Frailty and multimorbidity: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci.  https://doi.org/10.1093/gerona/gly110 CrossRefPubMedGoogle Scholar
  20. 20.
    Shah P (2002) Graph comprehension: the role of format, content and individual differences. In: Anderson M, Meyer B, Olivier P (eds) Diagrammatic representation and reasoning. Springer, London, pp 173–185CrossRefGoogle Scholar
  21. 21.
    Ruiz JG, Andrade AD, Hogue C et al (2016) The association of graph literacy with use of and skills using an online personal health record in outpatient veterans. J Health Commun 21(sup2):83–90.  https://doi.org/10.1080/10810730.2016.1193915 CrossRefPubMedGoogle Scholar

Copyright information

©  This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply  2019

Authors and Affiliations

  1. 1.Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Veterans Successful Aging for Frail Elders (VSAFE)MiamiUSA
  2. 2.University of Miami Miller School of MedicineMiamiUSA

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