1. Marshall, Katherine DNP, PMHCNS-BC, NP, CNE
  2. Hale, Deborah MSN, RN, ACNS-BC

Article Content

Health literacy is defined as "the ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions and follow instructions for treatment" (Scott, 2019, p. 29). Close to 20% of American adults are unable to read and at least 30% cannot read at a fifth-grade reading level. Low health literacy predisposes individuals to poorer health and higher mortality compared with those with higher literacy skills.


Strategies for educating older adults must accommodate the physical, cognitive, or psychosocial changes related to aging. Patients with low vision will require larger font and increased contrast and white space in written material. Speak to hard-of-hearing patients in a quiet space and make sure they are using their hearing aids appropriately (if applicable). Speak in a moderate, unrushed manner. Cognitive/psychosocial changes include difficulty focusing, short-term memory loss, and changes in independence (Elliott, 2014). In these situations, home healthcare clinicians may also need to educate a caregiver while engaging the patient as much as possible.


Elliott (2014) utilized a variety of strategies tailored to maximizing the strengths of older adults coping with chronic kidney disease. These strategies were borrowed from Speros (2009), "Age Appropriate Teaching Strategies for the Older Adult."


* Schedule teaching sessions in mid-morning when energy levels are usually highest for older adults.


* Provide more time for older adults to process new information. Pausing after each new concept will help to validate their understanding.


* Link new knowledge or skills to clearly identifiable past experiences. Reminiscing and storytelling help older adults reconnect with lived experiences.


* Minimize distractions, limiting the message to a few (five or less) essential key points and avoid unnecessary information.


* Speak slowly, but not so slowly that the patient becomes distracted or bored. Face the patient when speaking and sit at the same level as the patient.


* Give older adults written material that reinforces the major points of the teaching. Text should be easy to read (5th grade or below), using large print (14 to 16 point font) with high contrast between the print color and paper (preferably black print on white or light cream, non-glare paper).


* Use visuals which represent older adults in a positive way, avoiding stereotypic cartoons and situations that are not relevant and could be perceived as disrespectful.


* Encourage patients to keep written information near a phone, on the bedside table, or on the refrigerator so it can be easily retrieved.


* Encourage family members, caregiver, or friends to actively participate in the educational sessions.


* Be mindful of older adult's physical comfort level, individuals in pain or experiencing anxiety are not fully available to comprehend new or complex information (Elliott, 2014; Speros, 2009).



Home healthcare clinicians may find a need for more help or support with health literacy concerns. A few support sites include:


* The U.S. Department of Health and Human Services, Quick Guide to Health Literacy and Older Adults:


* Health Resources and Services Administration (HRSA), Healthy Literacy:


* National Institute of Health, the U.S. National Library of Medicine, Medline Plus, Health Literacy:





Elliott R. W. (2014). Educating older adults with chronic kidney disease. Nephrology Nursing Journal, 41(5), 522-525, 528. [Context Link]


Scott G. A. (2019). Health literacy and the older adult: A persistent and widespread problem. The Clinical Advisor, 22(3), 29-34. [Context Link]


Speros C. I. (2009). More than words: Promoting health literacy in older adults. Online Journal of Issues in Nursing, 14(3). [Context Link]