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

描述（由申请人提供）：一名新研究者向NIA提交的R21申请，探讨了55岁及以上人群的认知、健康素养和出院后结果的特定方面之间的关系。拟议的研究与NIA的行为和社会研究以及老年病学和临床老年学项目的重点领域有关。具体而言，它涉及推理和决策、情境认知、残疾和影响老年人健康的干预措施。该建议具有创新性和探索性，因为它将认知神经科学的理论和经验衍生的概念应用于健康素养和护理转变的发展研究领域，特别是关于出院时的教育需求。该建议将评估住院老年人出院前的健康素养和认知。对出院计划具体内容的遵守情况将在大约一周后进行测量。该建议的具体目的是：目的1：确定老年人出院时认知缺陷的患病率、类型和严重程度。感兴趣的认知变量包括工作记忆、语义学习能力和行为自我调节能力。目的2：在出院后一周的随访评估中确定认知缺陷对出院指示回忆和执行的影响程度，并评估三个感兴趣的认知变量与健康素养之间的关系。目的3：探讨这些发现如何为干预措施提供信息，以根据出院时评估的个人认知能力和健康素养量身定制出院指示。许多老年患者出院回家时对出院说明的理解有限。这种认识的缺乏对功能恢复和治疗计划的依从性产生不利影响。有人认为，这一问题与患者健康素养有限有关。我们之前的研究表明，认知的个体差异可能在健康素养和健康结果中发挥重要作用。在设计和测试干预措施以提高卫生素养之前，需要更全面地了解认知的基本子组成部分的作用。

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.