Health Literacy in Elderly Patients - Term Paper Example

Health Literacy in Elderly Patients xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Name xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Course xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Instructor xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Date Introduction A community is a group of people or persons living together in a place sharing certain attitudes interests in common. It can also be described as a condition of sharing, having things in common or being alike in some way (Hornby, 2010). As a home-visiting registered nurse working for a private organization, my role is to provide health care for older clients who are suffering from Chronic Obstructive Pulmonary Disease (COPD) but are receiving care from different health practitioners. Most of the patients in this age group are faced with difficult treatment decisions and complex information. The lives of these clients are mostly restricted to the perimeters of their homes because of the complexity of their conditions and age. Most of them get shortness of breath and so require oxygen tanks and other complex machinery to walk around. The immobility and lack of health literacy makes their health conditions deteriorate as time goes by. Basically, I have noted that these patients are confused about their treatments. Health literacy is defined as the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health (World Health Organization 2009). Older adults with low literacy levels have poor understanding of disease, less knowledge about their treatments, and poor decision making on matters affecting their health. Categories of Health Literacy 1. Below basic: - can do tasks with small and not co complicated texts and documents. Older adults can find a piece of information in a pictorial or in a news story. 2. Basic: - can find information in words, make inferences and integrate pieces of identifiable information. 3. Intermediate: - can be able to integrate information from long words, do appropriate operations in arithmetic and identify quantities required to perform the arithmetic operation. 4. Proficient:-is proficient in documents with long and complex texts (Marks & Ray, 2012) For the health group under consideration, the majority of the patients fall in the “Below basic” and “Basic” categories. I will examine the various effects of health literacy in elderly clients with chronic respiratory problems. Importance of health literacy Literacy is not all about writing and reading. Rather, it enhances the capacity of people to make sound decisions and have control over their lives. Health literacy is fundamental to well-being in the 21st century and is supported by the World Health Organization (WHO) Millennium Development Project. Health literacy is critical in enforcing efforts to foster a patient’s ability to manage their own health (World Health Organization, 2013). Mental health literacy is also an essential prerequisite of recognition of widespread problems. I have observed that mental disorders among older patients are always realized early and so mental health and literacy cannot be separated from this group of patients. Health literacy in elderly patients is important since they are required to: 1. Analyze risk and benefits of treatments. In my knowledge Patients are required to have good analyzing skills so as to correctly interpret results 2. Be knowledgeable on how to calculate dosage. Having knowledge on how to calculate ones dosage is very vital. Health literacy provides enough knowledge to do this. 3. Know where to locate information. I have noted there’s need for patients to know where they should locate information and help regarding their health. Patients should be visual literate, computer literate, information literate and numerical literate. Impact of health literacy to patients with COPD Health literacy is highly associated with having the capacity to obtain, process and understand basic health information needed to make sound health decisions (Hill, 2011). In my observation health literacy among older clients with chronic respiratory problems is crucial. Individuals with health literacy have more: 1. Understanding on their conditions. 2. Better symptom management. 3. Higher adherence to medical recommendation 4. Reduced hospitalization. Reduced burden on the health care system. 5. Improves confidence and self esteem (Hill, 2011). Impact of reduced health literacy Low health literacy level is a major source of inefficiency and potential poses an immense financial burden for the future generations wherever it occurs. (Marks, p. 7, 2012). People who do not know how to read are more likely not to seek care and receive treatment. This group also has additional costs in terms of low esteem and general efficacy to take care of oneself. I have noted that patients with limited health literacy often have difficulty weighing risks and benefits. They also have a tendency of not involving health care providers in questions finally their quality of care may suffer because they may not come for needed care, or they may underutilize preventive health care services simply because they fear filling o of forms or questionnaires in relation to their health and health practices. Some of the impacts of reduced health literacy to patients include minimal ability to understand medical information, increased likelihood of misreading prescription and drug labels, less ability to manage oneself, high mortality rate, and indulgence in risky behaviors among others (Health Literacy, 2012) Low health literacy levels may also prevents the attainment of medical diagnosis which is accurate leading to impeding of appropriate treatment recommendations Reasons for limited health literacy Almost 90 million of adults in America have a low health literacy level. Low health literacy is higher among people with low socioeconomic status, low education and limited English proficiency as well as the older individuals with mental or physical disabilities. Academic literacy is more focused on skills such as reading, writing and arithmetic (Hernandez, 2009). However, functional literacy skills are focused or involve putting into real world practice a number of cognitive and non-cognitive problem solving technicalities, interpersonal and life learning skills. Academic literacy is considered to be individual and transferable across one person to another while functional literacy skills are all about what an adult can do and not what they are capable of doing (McCormack, 2009). Functional skills are social and change from time to time e.g. an adult can have much functional literacy like he/she can know how to use a computer but not necessarily know how to read the manual or understand programming and coding. Functional health literacy helps people know how to use the health care system and take care of oneself but not necessarily to understand technical medical terminology. Functional and academic skills in older adults are vital for health literacy (Keleher & Hagger, 2007). 1. Complexity of written information. Health education and promotion are vital for empowering the elderly and vulnerable. So much health education on print and web is written at high reading level such that it’s far out of reach for an average patient (Zarcadoolas, Ahern, &Blanco, 2007). I have noted that a lot of jargons are used to provide information which is too complex to elderly adults whose level of education is not up to par. 2. Lack of information in other languages. Most of the health information on print and media are written in English. 14 percent of the populations in America are non-English speaking. The lesser population of Hispanics, Chinese French and natives are disadvantaged in accessing health information, in addition to being less well-off economically (Schiek, 2011). 3. Lower reading skills. Quiet a population in America doesn’t know how to read. This has a big impact on health literacy and how to improve it. 4. Learning disabilities. From my observations older people who are blind deaf or dumb are quiet a disadvantaged group. How to promote health literacy 1. Intervention and educational programs In my research I have noted that use of plan action with chronic obstructive pulmonary disease patients can reduce unscheduled consultations and reduce mortality (Sridhar et al, 2008). Use of self-management strategies to increase medication adherence should also include self-monitoring and checking inhaler techniques. 2. Use of pictorial aids Older adults learn better from visual presentation than auditory presentation of information. During the study I have realized that use of pictorial and verbal communication has been shown to be most effective in increasing patient understanding and compliance (Osborne, 2013) 3. Consultation with patients Osborne (2013), states that consultations may be done by giving the patient written advice such as leaflets with information detailing their individual medication. This method has proved effective in alleviating health illiteracy especially within my patients. The information presented should be as simple as possible and without jargon. 4. Encourage patients to come along with a literate person. Through my working career I have always insisted that my patients with no knowledge of health literacy be accompanied with a person who has good literacy skills. This will ensure that the patient has a guardian to guide him through his illness and medication in case he doesn’t understand. 5. Do a follow up To conclude telephone follow up on your patients with no health literacy has proved to be vital to maintain adherence. Conclusion To achieve health literacy among the elderly suffering from chronic obstructive pulmonary disease a number of measures have to be put in place. I propose that the measures below should be put in place. 1. Centered communication As a nurse I try as much and engage my patients in a conversation in form of questions to uncover the knowledge deficits or health beliefs. At this point I always try to address many patients’ main concerns which are often what they need to do rather than what they know already. 2. Confirmation of understanding Confirmation of understanding is important in good communication. However, asking patients if they understood you or if they have any more queries is an effective means of checking whether a patient understands. In my observation this should be avoided at all costs but should be avoided. Instead of asking if they have any questions or if they need you to clarify more on a certain area should be encouraged. This encourages patients that should they have more questions they are allowed to ask. It also empowers them to get their questions answered (Sadock, 2007). After answering a patients question I usually ask my patients to repeat back to me what I have just taught them. This is important as it confirms a patients understanding. 3. Clear and evident health communication Older patients affected with chronic respiratory problems often depend on verbal instructions and therefore verbal instructions should be very clear. I suggest that health practitioners down their speech use plain language and avoid jargon because successful communication requires a patient to draw from a common vocabulary or experience. Health practitioners should also try to prioritize and limit the number of key points discussed to less than three (Sadock, 2007) 4. Emphasis on modalities In addition to using clear verbal instructions, I have noted that there’s need for additional emphasis of modalities e.g. drawing of charts and pictures. Giving both written and from mouth information increases knowledge and satisfaction compared to giving verbal information only. The major key points to follow in attaining this is through the use of large fonts, use of passive voice (which is a bit gentle and soft) keeping sentences short straight to point and use of pictures. 5. Medication reconciliation Dosing schedules should be included in patient’s daily routines. It is important to confirm dosage so as to promote safety and effectiveness. Involve the patient in questions such as “show me how to exactly use your inhaler” incorrect answers to such question can then lead to further interventions. Additionally, patients should be able to recognize the medications by name rather than color or appearance (Heuer, Gedde & Lewis, 2008) Creating an empowering environment Many of the patients I have handled that are suffering from chronic respiratory problems experience shame and therefore implicit imbalance between patient health practitioner relationships. I recommend that creating an empowering environment within the hospital setting is important. Strategic changes in the hospital settings can be through structured assessment. An empowering environment can be achieved by encouraging questions (Hewitt, 2011). It is also important to obtain the help of other health practitioners such as pharmacists to help with medication, nutritionists to help in diet management and any others in the health field. In my practice I use immediate family members or a support group of my patients to reinforce the information I give them during the visits. Summary It is clear that low health literacy is prevalent and is associated with many poor health outcomes in patients with chronic respiratory problems. Many of the poor outcomes may be caused by inadequacies in health practitioner – patient system and system-patient communication. Interventions at the practitioner-patient level (e.g. clear communication techniques), at the system-patient level (e.g. clear educational materials) and at community – patient level (e.g. adult education) can improve care for older patients suffering from chronic respiratory problems with low literacy levels (Joint Commission Resources, 2010). These actions will go a long way in improving health literacy levels and the overall well-being of elderly patients suffering from OCPD. References Health Literacy. (2012, November 20). National Network of Libraries of Medicine (NN/LM) Home Page. Retrieved April 24, 2013, from http://nnlm.gov/outreach/consumer/hlthlit.html Health Promotion. (n.d.). World health Organisation. Retrieved April 25, 2013, from www.who.int/healthpromotion/conferences/7gchp/track2/en/ Hernandez, L. M. (2009). Approaches to Assessing Health Literacy levels. Measures of health literacy workshop summary (pp. 43-44). Washington, D.C.: National Academies Press. Heuer, D. K., Gedde, S. J., & Lewis, R. A. (2008). Curbside consultation in glaucoma: 49 clinical questions. Thorofare, NJ: SLACK. Hewitt, M. E. (2011). Improving health literacy at the Community level. Improving health literacy within a state workshop summary (pp. 51-74). Washington, DC: National Academies Press. Hill, L. H. (2011). Health Literacy. Adult Education for Health and Wellness New Directions for Adult and Continuing Education. (pp. 45-49). New York: John Wiley & Sons. Hornby, A. S., & Turnbull, J. (2010). Oxford advanced learner's dictionary of current English (8th ed.). Oxford [England: Oxford University Press. Keleher, H., & Hagger, V. (2007). Health Literacy in Primary Health Care. Australian journal of primary health, 13(2), 25-26. Marks, R. (2012). Health Literacy and School-Based Education. Bradford: Emerald Group Pub.. McCormack, L. (n.d.). WHAT IS HEALTH LITERACY AND HOW DO WE MEASURE IT?. Approaches to Assessing Health Literacy. Retrieved April 26, 2013, from http://www.ncbi.nlm.nih.gov/books/NBK45378/ Osborne, H. (2013). Visuals. Health literacy from A to Z practical ways to communicate your health message (2nd ed., pp. 215-220). Burlington, MA: Jones & Bartlett Learning. Resources, I. (2008). Theory in Action. High-alert medications: strategies for improving safety (pp. 116-121). Oakbrook Terrace, Ill.: Joint Commission Resources. Sadock, B. J., & Sadock, V. A. (2007). Interviewing Techniques with Special populations. Kaplan & Sadock's study guide and self-examination review in psychiatry (8th ed., pp. 11-13). Philadelphia: Wolters Kluwer Health / Lippincott Williams & Wilkins. Schiek, D. (2011). European Union non-discrimination law and intersectionality investigating the triangle of racial, gender and disability discrimination. Burlington, VT: Ashgate Pub.. Sridhar, M., R, T., S, D., & J, R. N. (2008). A nurse led intermediate care package in patients who have been hospitalised with an acute exacerbation of chronic obstructive pulmonary disease. London: B M J Group. Zarcadoolas, C., Pleasant, A. F., & Greer, D. S. (2012). Advancing health literacy: a framework for understanding and action. San Francisco, CA: Jossey-Bass. Read More