1. Clark, Diane PT, DScPT, MBA

Article Content

Limited health literacy is one of the most significant challenges that faces our health care system today.1-6 Research in this area has grown extensively over the past 20 years, and, yet, best practices related to managing limitations in health literacy have not been consistently implemented by health care professionals.7-9 Older adults are at high risk to have limited health literacy skills.10 In addition, they experience sensory, cognitive, and motor impairments that are associated with a decreased ability to find and use information to manage health conditions and make informed decisions related to their health.11 Many older adults have chronic health diseases that involve complicated self-management strategies and complex medication regimens that may require daily modifications in response to changing physiological values.12 As a culturally diverse group, older adults are better able to understand and use information when health care professionals are sensitive to communication preferences and present information in plain language.13


As rehabilitation professionals, we are uniquely positioned to address the issue of limited health literacy in older individuals who seek our services. We frequently have opportunities to work with them for extended periods of time over multiple sessions. Many of us use recommended strategies such as the Teach-Back Method14 to assess learning in older adults who are instructed in new skills. The 5 articles in this issue provide a comprehensive overview of key concepts related to health literacy and best practices associated with its management in rehabilitation of the older adult. The first article defines health literacy and the scope of the problem of limited health literacy in the aging population. Nemmers, Jorge, and Leahy discuss conceptual frameworks for understanding how limited health literacy is linked to poor health outcomes, and provide an overview of initiatives and interventions to address limited health literacy. Clinical measurement of health literacy is presented in the next article and includes descriptions of commonly used instruments as well as a discussion of their value in clinical practice. Pearce and Clark then discuss evidence-based strategies to address limited health literacy. Readers are provided with best practices in verbal, written, and electronic modes of communication to enhance health literacy and promote cultural competence when working with diverse older adult populations. As many older adults experience visual impairments, Warren examines the issues encountered by visually impaired older adults and how rehabilitation professionals can address this challenge in their practices. Finally, Rios considers the concept of eHealth literacy in older adults. While older adults are increasingly turning to electronic resources and social media to obtain health information, Rios discusses the limited evidence related to the effectiveness of this modality in the older population and provides recommendations for future research.


The contributors to this special issue hope that readers will reflect upon the information provided regarding limited health literacy in the older adult and consider how communication practices may be strengthened to improve care and outcomes. While previous research has centered upon individuals' health literacy skills, future emphasis will be placed on health care professionals' competence in managing health literacy issues.15 Rehabilitation professionals working with older adults have an opportunity to provide leadership in the adoption of best practices in health literacy at the organizational, local, and national levels.


-Diane Clark, PT, DScPT, MBA


Department of Physical Therapy


The University of Alabama at Birmingham




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