LitCog IV: Health Literacy and Cognitive Function Among Older Adults

摘要 我们要求继续我们的NIA队列研究(‘LitCog’；R01AG030611)。LitCog研究 医疗发病率增加导致复杂的患者自我管理(SM)角色，以及认知能力下降， 这可能会影响老年患者的健康素养(HL)技能和慢性病自我护理。在功能上独立， 年龄在55-74岁(N=900)的“认知正常”成年人是从芝加哥的社区初级保健诊所招募的。 参与者已经完成了全面的认知、心理、社交、行为和功能健康 每3年进行一次评估(4次面谈；2008-2018年)。样本因种族、社会经济地位和 医学发病率；在认知老化研究中不常见。第一次续订奖(LitCog II)审查了更改 在认知方面，6年以上的HL和SM技能及其与身心健康的关系。我们发现 认知功能与HL密切相关；随着时间的推移，两者都会一起衰退。认知功能与HL 也决定了老年人的SM技能；所有这些都预测了功能性健康状态及其下降。第二次续订(LitCog Iii)使我们能够通过医疗记录新的健康行为、慢性病后果和医疗保健使用情况， 药房的记录是基线后的十年。认知功能、HL和SM技能影响所有这些结果。 LitCog III几乎完成；900名受试者中有774人(86%)还活着，可以进行进一步研究。 我们现在提议在基线后12年和15年后进行后续评估(LitCog IV)。有6个 在15年的采访中，认知、HL、SM技能和健康状况的具体下降轨迹可以是 经过仔细研究。发病率、残疾、认知障碍的患病率和对其的调整 (包括阿尔茨海默病和相关痴呆症(ADRD))为研究提供了新的结果。死亡率 数据现在也将随着更长的后续行动而可用。我们的主要目标是1)评估认知方面的轨迹 15岁以上老年人的功能、HL和SM技能，以及它们与健康结果的关系。 LitCog是一项非常独特的认知老化队列研究，因为它是在卫生服务的背景下进行的 研究。我们的目标是通过以下方式向卫生系统提供有效管理老年患者的策略 了解认知如何改变和影响实现最佳健康所必需的HL和SM技能。 可能调节/缓和关联的可修改因素也被探索为潜在的干预目标。 照顾者的参与和作用已经明确地成为患者的一个重要的社会决定因素 健康。ADRD行政副刊(LitCog IIIA)扩大了我们的调查范围，包括采访 护理员(非正式或有偿)参与支持60%参与者的护理。在LitCog IV中，我们将创建一个 平行照顾者队列，次要目标是2)调查存在与 参与照顾者的治疗依从性、慢性病结局和功能健康状况 老年人；3)确定影响照顾者参与和患者结局之间的关联的因素。

ABSTRACT We request to continue our NIA cohort study (‘LitCog’; R01AG030611). LitCog studies the confluence of increased medical morbidity resulting in complex patient self-management (SM) roles, and cognitive decline, which may affect older patients’ health literacy (HL) skills and chronic illness self-care. Functionally independent, ‘cognitively normal’ adults ages 55-74 (N=900) were recruited from community primary care practices in Chicago. Participants have completed comprehensive cognitive, psychological, social, behavioral, and functional health assessments every 3 years (4 interviews; 2008-2018). The sample is diverse by race, socioeconomic status and medical morbidity; uncommon among cognitive aging studies. A 1st renewal award (LitCog II) examined changes in cognition, HL and SM skills over 6 years and their associations with physical and mental health. We found cognitive function to be strongly associated with HL; both decline together over time. Cognitive function and HL also determine older adults’ SM skills; all predict functional health status and its decline. A 2nd renewal (LitCog III) has allowed us to capture new health behaviors, chronic disease outcomes, and healthcare use from medical, pharmacy records a decade post-baseline. Cognitive function, HL and SM skills impact all of these outcomes. LitCog III is almost complete; 774 of 900 (86%) subjects are alive and available for further study. We now propose to conduct follow-up assessments 12 and 15 years post-baseline (LitCog IV). With 6 interviews over 15 years, specific trajectories of decline in cognition, HL, SM skills and health status can be closely studied. The prevalence of and adjustment to increasing morbidity, disability, cognitive impairment (including Alzheimer’s Disease & Related Dementias (ADRD)) allow for new outcomes for investigation. Mortality data will also now be available with extended follow-up. Our primary aim is to 1) evaluate trajectories in cognitive function, HL and SM skills over 15 years among older adults, and their associations with health outcomes. LitCog is an exceptionally unique cognitive aging cohort study as it is framed in the context of health services research. Our goal has been to inform health system strategies for effectively managing older patients by understanding how cognition changes and influences HL and SM skills necessary for achieving optimal health. Modifiable factors that may mediate/moderate associations are also explored as potential intervention targets. The involvement and roles of caregivers has specifically emerged as an important social determinant of patients’ health. An administrative ADRD supplement (LitCog IIIA) has expanded our inquiry by including interviews with caregivers (informal or paid) involved in supporting the care of 60% of participants. In LitCog IV, we will create a parallel caregiver cohort, with the secondary aims to 2) investigate associations between the presence of an involved caregiver with treatment adherence, chronic disease outcomes, and functional health status among older adults; 3) identify factors influencing associations between caregiver involvement and patient outcomes.