Carolyn Speros

Inadequate health literacy disproportionately affects older adults in the United States. The complexities associated with managing chronic disease and the cognitive and sensory changes associated with aging compound the challenges of teaching this highly vulnerable group. In order to enhance comprehension and bring about positive health behavior changes, the nurse must use more than words when teaching an older adult. Multiple teaching strategies that are tailored to accommodate the cognitive, physical, and psychological changes associated with aging, such as clear communication that is purposeful and individualized and a patient-centered approach that demonstrates acceptance and respect, are actions that the nurse must take to promote health literacy in the older adult. This article describes the effect of age-related changes on health literacy, addresses the challenges inherent in communicating with and teaching older adults, and suggests age-appropriate teaching strategies that the nurse can implement to improve the health literacy of an aging patient. Suggestions for evaluating comprehension are also provided.

Aim.  This paper reports an analysis of the concept of health literacy in order to clarify its meaning, reduce ambiguities associated with references to it, and promote consistency in using the concept in nursing dialogue and research.Background.  Health literacy is a relatively new concept in health promotion research. Only within the last decade have researchers identified the problems associated with health literacy, the role it plays in an individual's ability to comprehend health and self‐care information, and its relationship to health outcomes. Clarifying the concept is essential so that nurses develop an awareness of the phenomenon and its relationship to the outcomes of their communication and health education efforts.Method.  The method used for this concept analysis was that of Walker and Avant (1995).Findings.  Health literacy empowers people to act appropriately in new and changing health‐related circumstances through the use of advanced cognitive and social skills. The defining attributes of health literacy are reading and numeracy skills, comprehension, the capacity to use information in health care decision‐making, and successful functioning as a healthcare consumer. Antecedents of health literacy are literacy and a health‐related experience. Consequences of health literacy include improved self‐reported health status, lower health care costs, increased health knowledge, shorter hospitalizations, and less frequent use of health care services. Empirical referents of the concept are the Test of Functional Health Literacy in Adults and the health literacy component of the National Assessment of Adult Literacy.Conclusions.  An analysis of the concept of health literacy enhances nurses’ ability to assess more accurately their clients’ levels of health literacy, thus identifying those at risk for misunderstanding health care instructions, shame associated with inadequate reading skills, and inability to adhere to health care recommendations.