Inadequate health literacy and more hospitalisation among frail older adults in Hong Kong

Abstract

Background. Older adults with inadequate health literacy (IHL) have difficulty to understand health information, adhere to a treatment regimen, and implement self-care. This study aimed to assess the prevalence and contributing factors of IHL in community-dwelling older adults in Hong Kong and to describe the relationship between IHL and different health outcomes. Method. This was a secondary data analysis using a large cohort of community-dwelling Chinese older adults who applied for subsidised long-term care services in Hong Kong in 2012. IHL was measured using the Rapid Estimate of Inadequate Health Literacy (REIHL). Socio-demographic factors and health outcomes (frequency of falls, hospitalisation, and use of an emergency service in the last 90 days) were assessed. Chi-square test and t-test were used to analyse the bivariate relationship between IHL and contributing factors, as well as health outcomes. Linear regression models were used to assess the effect of IHL on health outcomes. Results. A total of 4589 older adults were included; 50% were married and 44% were male. 62.11% of respondents had IHL: more were female than male (74.01% vs. 46.9%, p<0.001) and more were unmarried than married (69.02% vs. 55.45%, p<0.001). 64.39% of the older adults who lived alone had IHL. IHL was associated with frequency of falls (p<0.05). After controlling for gender, marital status, and living arrangement, older adults with IHL were more likely to be hospitalised (beta=0.1044, p<0.001). Conclusion. The prevalence of IHL was high among community-dwelling frail older adults in Hong Kong. Those who were female, unmarried, and live alone were more likely to have IHL. They should be the target group for any health literacy enhancement programme. Older adults with IHL seem to be at risk of hospitalisation. The challenge is how to support these community-dwelling older adults and maintain good health.