Influence of Cognition on Health Literacy and Comprehension of the Discharge Plan

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DESCRIPTION (provided by applicant): This R21 application to NIA by a new investigator explores the relationships between specific aspects of cognition, health literacy, and post-hospital-discharge outcomes in people aged 55 and over. The proposed study is related to areas of emphasis for NIA's Behavioral and Social Research and Geriatrics and Clinical Gerontology Programs. Specifically, it addresses reasoning and decision-making, cognition in context, disability, and interventions affecting the health of older persons. This proposal is innovative and exploratory in that it applies theoretically and empirically-derived concepts from cognitive neuroscience to the developing research areas of health literacy and care transitions, specifically concerning the educational demands at the time of hospital discharge. This proposal will assess health literacy and cognition in a population of hospitalized older adults prior to discharge. Adherence to specific elements of the discharge plan will be measured approximately one week later. The Specific Aims of this proposal are: Aim 1: To identify the prevalence, type, and severity of cognitive deficits present in older adults at hospital discharge. Cognitive variables of interest include working memory, semantic learning ability, and the capacity for behavioral self-regulation. Aim 2: To determine the degree to which cognitive deficits influence recall and execution of discharge instructions at a follow-up assessment one week after discharge, and to evaluate the relationships between the three cognitive variables of interest and health literacy. Aim 3: To explore how these findings might inform an intervention designed to tailor discharge instructions to an individual's cognitive ability and health literacy assessed at the time of hospital discharge. Many older patients return home from the hospital with only a limited understanding of their discharge instructions. This lack of understanding adversely affects functional recovery and adherence to treatment plan. It has been argued that the problem is related to limited patient health literacy. Our previous research suggests that inter-individual variability in cognition is likely to play an important role in both health literacy and health outcomes. Before interventions can be designed and tested to improve health literacy, a more complete understanding of the role of basic subcomponents of cognition is needed.