Older Adults: Support For Health and Financial Literacy

Supporting health and financial literacy is necessary for healthcare and community-based providers working in urban and rural settings. Providers may be puzzled when individuals who seem interested in receiving support fail to follow through with recommendations or miss appointments.

Appointment no-shows may be documented in medical charts as non-compliance when literacy, language, or mental processing difficulties may be the underlying cause. Individuals who struggle with language difficulties may hesitate to ask questions. Many older adults view physicians as authorities, so they don’t ask questions. 

But what about older adults who experience memory loss? How can providers distinguish this population from others with language or learning gaps without appearing biased?

Older Adults Are More Likely to Experience Memory Loss

Sixty percent of adults, aged 65 and over, (before a diagnosis of memory loss) have basic or below-average health literacy. (1) Due to chronic diseases, adults can experience normal changes in memory and executive function that make it more difficult to follow through with health recommendations.

A diagnosis of memory loss or Alzheimer’s disease results in subtle early difficulties and an eventual total inability to receive, evaluate information, and make appropriate decisions. Research confirms that the presence of the APOE 4 Allele, a genetic risk factor for Alzheimer’s disease, is associated with lower health and financial literacy. (2)

Armed with this information, how can healthcare providers adjust their communication skills to help persons with low health or financial literacy or those diagnosed with early-stage memory loss participate in health recommendations

Communication Tips for Healthcare Providers

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Care managers, care coordinators, and community health workers in community-based organizations, hospitals, nursing homes, and other outpatient services can be a source of support. Individuals on care teams may be assigned to help with patient care coordination efforts. 

Because primary care physicians work on tight schedules, appointments can run more smoothly when care coordination staff re-confirms understanding of follow-up appointments, prescribed medications, and treatments. Most patients who struggle to navigate the healthcare system, appreciate the additional support so everyone benefits. 

Practicing the tender-receiver model of communication can improve follow-through. Care coordinators focusing on supporting individuals with health and financial literacy might schedule regular contact with patients. By checking in, patient concerns about transportation to appointments, co-pays, or medication costs can be identified and resolved. These actions can eliminate missed appointments or unnecessary hospital visits. 

Effects of Low Health and Financial Literacy for Older Adults

Low health literacy can result in a variety of challenges. These include locating health services like physicians, therapists, medical offices, labs, and diagnostic testing locations.

Reviewing documents and filling out forms is normal for receiving medical care. The information in most forms is too complicated to understand. This means that forms are signed to receive medical care without comprehension of the consent provided.

The ability to report and share medical history with providers may be difficult, resulting in poor chronic disease management. Most patients don’t know what questions to ask about a diagnosis or the reason for being prescribed medication, even when a provider attempts to confirm understanding. 

Difficulty understanding and following directions on prescription labels results in unnecessary hospitalizations. Many adults do not take medications as prescribed or have prescriptions filled due to the cost. 

Low financial literacy contributes to difficulties in evaluating the costs and benefits of health and prescription medicines. Knowing what costs correspond with co-pays and deductibles can take time to investigate and understand. Most consumers can’t spend time during the workday to call insurance companies to ask about benefits. 

From a financial perspective, budgeting retirement income and savings to pay for housing, health care, and daily living expenses can be difficult. How many of you keep an up-to-date spreadsheet of monthly income and expenses? The simple task of balancing a bank statement can be challenging if one does not have good math skills. 

For older adults, gaps in math skills and computational abilities can show up in the form of bounced checks, unpaid bills, or utility shutoffs. Some older adults donate to charities, yet they struggle to pay for rent or buy groceries.

The ability to manage finances is a gap as individuals begin to experience memory loss. Financial exploitation of older adults can be common for older adults with low incomes who may be swayed by promises of winning money or lottery sweepstakes.

Care Coordinators Can Be Care Advocates

A care advocate can support various concerns, including health and financial literacy education. It is common for patients to benefit from in-depth discussions about how care decisions today impact overall well-being. 

The effects of a health diagnosis on daily activities may not be considered due to difficulties with evaluating and understanding information. There may be a sense of “I’ll worry about it tomorrow,” because healthcare and other professionals don’t have time or fail to offer easy-to-understand explanations.  

A care advocate can become a trusted partner for patients needing more time and attention. The care advocate’s discussion plan can be developed based on patient needs. 

The teach-back method can be used to confirm that patients understand the information provided. Communication is a complex activity that is easily assumed to be effective. Providers would be surprised at how often information communicated is not received accurately by patients.

Conversations initiated by an experienced care advocate can empower younger and older adults to make decisions and provide a sense of choice.

Aging and Change: The Stressors of Life Transitions

Responding positively to the changes of aging can be challenging without support. The stressors of life transitions may result in feelings of overwhelm, stress, fear, and dread.

While those younger look forward to retirement, many have little insight into the added pressures that retirement and being on fixed incomes place on health and financial management. 

For older adults, when health changes, daily routines can change. Persons working in the aging industry know that a daily routine is extremely important for well-being.

For retirees, communication with work acquaintances ends, and isolation can increase. Unless outside friendships are nurtured, older adults may experience depression and loneliness. These concerns heightened during the pandemic remain concerns today.

Changes or declines in health after retirement may limit the ability to socialize and participate in activities outside of the home. If one spouse has health concerns, the role of caregiver now becomes the daily responsibility of the healthier spouse.

Adult children who intend to be helpful but who are rushed for time, can “take away” activities that provide a sense of purpose for a parent. Changes in routine and the loss of friends or physical activities can mean that older adults need support with coping skills.

Older adults who struggle with simple things they used to do can experience an ongoing sense of overwhelm. Stress can result in memory concerns, including the ability to focus and to remember to complete daily activities.  

Let’s look at the effects of chronic disease and stress on memory loss. 

Mild Cognitive Decline: A Risk Factor for Alzheimer’s Disease or Dementia

The statistics for the diagnosis of memory loss are staggering. In 2018, the number of Americans diagnosed with Alzheimer’s disease was 5.7 million. By 2050, the number diagnosed will increase to 13.8 million. Alzheimer’s disease is the 6th leading cause of death. (3)  

Primary care physicians have limited experience with diagnosing memory loss. If patients do not ask, physicians rarely initiate the conversation about memory loss.

Individuals with low health literacy may not be aware of the early signs of memory loss or be fearful of receiving the diagnosis. This lack of questioning by older adults and lack of initiating the discussion by physicians prohibits individuals from planning for future care needs.

Mild cognitive decline that advances year by year can eventually result in a diagnosis of Alzheimer’s or dementia. Individuals with a family history of memory loss or Alzheimer’s disease may be more proactive in wanting to know the likelihood they may receive a similar diagnosis or have the APOE4 Allele gene.

For these individuals, having the experience of caring for a loved one with Alzheimer’s Disease is usually the motivation to participate in testing. Many older adults want to avoid being a burden to their families.

The opportunity to plan may offer a sense of control over the future. For those with a family history, a voluntary genotyping assessment and ongoing assessments of cognition by neurologists and neuropsychologists may provide insights into the progression of memory loss. 

Research completed through the Rush Memory and Aging Project3 confirms that the presence of the APOE4 Allele, even in older adults without dementia, was associated with low health and financial literacy. This means that having the APOE4 Allele may not result in a diagnosis of Alzheimer’s but may still result in cognitive challenges.

With this knowledge, older adults and their families can discuss desires for care. Plans may be made for “what if” scenarios so that making decisions in a crisis may be avoided. Questions may be asked before memory becomes faulty.

A Care Advocate Can Initiate Conversations About Challenges in Health and Financial Literacy

Many older adults refuse help or deny the need for assistance as the result of fear or being perceived as being unable to manage their lives. Older adults are concerned about having their decision-making power taken away by adult children or other family members.

Having a conversation about health and financial matters can be successful if approached in a manner of questioning and concern rather than expecting what may be viewed as the correct response. Information is received in different manners. Older adults may not want to hear information perceived as bad news.

Below are suggestions to initiate conversations about health and financial literacy with older adults:

• Seek to understand. Speak less. Listen more. Ask questions. Do not immediately offer solutions. Take time to think about the information offered by older adults. Take notes.
• Be patient, and then count to 10 and be more patient. Older adults may not easily trust. Fear and confusion are often why older adults hesitate to make changes or to decide. Restate information, and ask for understanding. Ask the older adult to create a list of pros and cons to support decision-making.
• Carefully choose the words that are used. While one may automatically want to respond with “it will be okay” or “trust me,” these statements, while well intended, are of little comfort. It is better to empathize with a concern. The next step is to ask more questions about the concern so that there is an understanding of the basis. After asking initial questions, ask what the older adult believes would help resolve the concern. In some situations, the concern may not be immediately resolvable but may require a step-by-step plan.
• Be curious. Discuss the difficult subjects by asking a question. For example, “What will you do when this happens?”  Or “What would you like to happen if this happens?” Ask for preferences to better understand the older adult’s perspective, history, and skills related to decision-making.
• Do not expect immediate change or progress. Progress occurs in small steps that, when viewed in the future, are to be celebrated.
• Show appreciation. Thank the older adult for being open to having a conversation. This supports trust and lets older adults know you value their time and opinions.

It is important for professionals working in the healthcare industry to understand the impact of health and financial literacy on patient participation and engagement.

It is important to take time to explain information multiple times if necessary, and to be thorough in confirming understanding. It is easy to assume healthcare jargon is easily understood when patients fail to ask questions.  

Older adults are fearful or hesitant to ask questions. Many don’t know the questions to ask. This fear results in poor care and sometimes self-neglect.

As healthcare professionals, consider the type of care you desire for yourself or a parent. Remember this when working with older adults who seem slower physically or mentally. Offer your time and compassion in supporting older adults with health or financial literacy.

If you want more resources for caregiving families or yourself, check out Pamela’s complimentary online webinar program about caring for elderly loved ones.

Sources:
1. Improving Alzheimer’s Disease and Other Dementia Care Through Health Literacy. Wisconsin Health Literacy. Supported by a grant from Bader Philanthropies, Inc. http://www.wisconsinhealthliteracy.org

2. Christopher C. Stewart, et. al. Associations of APOE E4 with Health and Financial Literacy Among Community-Based Older Adults Without Dementia. J Gerontol B Psychol Sci Soc Sci, 2018, Vol. 73, No. 5, 778-786 doi: 10:10932/geronb/gbw-054

3. Alzheimer’s Association Report, “2018 Alzheimer’s Disease Facts and Figures,” Alzheimer’s & Dementia, 14 (2018) 367-429.

4. Rush University Memory and Aging Project. https://www.rushu.rush.edu/research/departmental-research/memory-and-aging-project

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