Health Literacy and Cognitive Function among Middle-Aged Adults: The MidCog Study

我们将扩大我们对老年人的积极研究，并招募一个中年人的平行队列，开始 对晚年认知障碍的较少研究的、可改变的中年决定因素的新研究。 研究成年中期（40-64岁）的认知变化可以阐明可能影响认知能力的可改变因素。 预防晚年认知障碍。到目前为止，很少有认知老化研究包括这个年龄组。那些 这些研究仅限于小样本或特定条件的样本，横断面分析或队列研究， 随访期、简化的认知测试、有限的协变量或研究样本缺乏多样性。但 许多已知的认知障碍因素在中年表现出来：1）慢性疾病，通常是延迟的， 在检测中，或由于治疗依从性差而管理不当; 2）未检测或未纠正 感觉障碍; 3）根深蒂固的生活方式行为;和4）常见的生物和心理社会压力。 因此，人们更加重视适当的健康自我管理和日常保健参与， 中年然而，许多美国成年人可能到了中年，缺乏熟练的“健康素养”，即收集信息的能力。 准确的自我保健知识，做出明智的健康决定，制定推荐的行为， 适当利用卫生服务。通过提高健康知识和自我保健，健康素养是可以改变的 这不仅是通过提高医疗技能，而且还通过减少卫生系统带来的治疗负担。促进健康素养可以改善 自我管理，增加常规医疗保健使用和改变生活方式;从而降低晚年生活障碍的风险。 自2007年以来，我们研究了认知能力下降如何影响健康素养，自我管理技能和健康 （R01AG030611）。我们积极的“LitCog”研究表明了认知功能如何影响健康 识字、自我管理和老年健康。但在中年，有限的健康知识和自我管理 技能可能会导致不健康的生活方式，慢性疾病，以及由于不频繁的医疗保健而导致的健康管理不善 使用和治疗依从性差-增加认知障碍的风险。我们的2020年LitCog更新增加了 第五、六次随访。我们试图启动一个平行的中年队列（“MidCog”;年龄40-64岁; N=1200）， 前两次评估相隔2.5年。我们的具体目标是：1）描述健康素养， 自我管理技能，以及中年人的详细认知功能; 2）评估协会 健康素养、自我管理技能、健康行为、医疗保健使用、健康状况、慢性病 随着时间的推移，结果和认知功能; 3）调查某些可改变的，心理社会的，中年的 健康素养、自我管理技能、健康状况和认知之间的相关因素; 4)使用MidCog + LitCog数据，探索年龄、健康素养、自我管理技能、健康 40至90岁成人的慢性病状况、存在和管理以及认知功能。我们将 补充现有的中年研究，并为卫生系统战略提供信息，以保护认知功能。

We will expand our active study of older adults and recruit a parallel cohort of middle age adults to begin novel investigations of less-studied, modifiable, midlife determinants of later life cognitive impairment. Studying cognitive changes in middle adulthood (ages 40-64) could elucidate modifiable factors that might prevent later life cognitive impairment. Very few cognitive aging studies to date include this age group. Those that have are limited to small or condition-specific samples, cross-sectional analyses or cohort studies with few follow-up periods, abbreviated cognitive tests, limited covariates, or a lack of diversity in study samples. But many known factors for cognitive impairment manifest in middle age: 1) chronic conditions that often are delayed in their detection, or inadequately managed due to poor treatment adherence; 2) undetected or uncorrected sensory impairments; 3) entrenched lifestyle behaviors; and 4) common biological and psychosocial stressors. Thus, greater attention is being paid to proper health self-management and routine healthcare engagement in midlife. Yet many U.S. adults may reach middle age lacking proficient `health literacy'; the capacity to gather accurate self-care knowledge, make informed health decisions, enact recommended behaviors and appropriately use health services. Health literacy is modifiable, by enhancing health knowledge and self-care skills, but also by reducing treatment burden imparted by health systems. Promoting health literacy could improve self-management, increase routine healthcare use and modify lifestyle; thus reducing risk of later life impairment. Since 2007, we have examined how cognitive decline affects health literacy, self-management skills, and health (R01AG030611) among older adults. Our active `LitCog' study has shown how cognitive function affects health literacy, self-management, and health in older age. But in midlife, limited health literacy and self-management skills may lead to unhealthy lifestyle, chronic disease, and poorly managed health due to infrequent healthcare use and poor treatment adherence - increasing risk of cognitive impairment. Our 2020 LitCog renewal adds a 5th, 6th follow-up interview. We seek to initiate a parallel, middle age cohort (`MidCog'; ages 40-64; N=1200), conducting the first two assessments 2.5 years apart. Our specific aims are to: 1) Characterize health literacy, self-management skills, and cognitive function in detail among middle age adults; 2) Evaluate associations between health literacy, self-management skills, health behaviors, healthcare use, health status, chronic disease outcomes and cognitive function over time; 3) Investigate whether certain modifiable, psychosocial, midlife factors moderate associations between health literacy, self-management skills, health status and cognition; and 4) Using MidCog + LitCog data, explore associations between age, health literacy, self-management skills, health status, presence & management of chronic disease, and cognitive function among adults ages 40 to 90. We will complement existing midlife research & inform health system strategies to preserve cognitive function.