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Health Literacy AmongInformal Caregivers of Persons With Memory Loss Judith A. Erlen, PhD, RN, FAAN; Jennifer H. Lingler, PhD, RN; Lisa K. Tamres, MS; Kidane B. Ghebrehawariat, MS; and Susan M. Sereika, PhD

University of Pittsburgh School of NursingSupported by NIH NINR P01NR010949

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Acknowledgements• Supported by NIH NINR P01NR010949 • Patients and their caregivers• Research Staff• Students• Community Advisory Board• Community liaisons

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Background• Caregivers of persons with memory loss face

increasing challenges over time

• Medication management is one such issue

• Of concern is the caregivers’ level of understanding of medication management

• Assessing health literacy is important

• Research describing the relationship between health literacy and correct medication management is limited

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Purpose

• To examine the relationships among

selected demographic variables, medication

taking deficiencies, and health literacy in a

sample of family caregivers of persons with

memory loss

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Methods: Overall Study• RCT designed to increase problem

solving related to medication management– Recruited patients with memory loss and

their informal caregivers from multiple community sites

– Eligible dyads were randomized to intervention and control following baseline data collection

– Intervention dyads were randomly assigned to either a nurse or a social worker

– All interventions and data collections occurred in the home or via telephone

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Methods: Current Study•Descriptive study

– Used baseline data •Analysis: •Descriptive statistics of caregiver and

patient data– Spearman correlation coefficient to

examine relationships

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Variables of Interest• Sociodemographic characteristics

– Gender, age, race, education, relationship to patient

• Number of co-morbidities• Health literacy

– Newest Vital Sign (NVS)• Medication errors

– Medication Management Instrument for Deficiencies in the Elderly (MedMAIDE)

– Medication Deficiency Checklist

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Newest Vital Sign (NVS)(Weiss et al (2005), Annals of Family Medicine)

• A brief health literacy screening instrument – uses a nutrition label accompanied by 6 questions – assesses numeracy and comprehension.

• Administration time is about 3 minutes. • NVS psychometrics:

– Cronbach’s alpha= .76– Correlates with the TOFHLA (r= 0.59, p< .001)

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Medication Management Instrument for Deficiencies in the Elderly (MedMAIDE)(Orwig et al (2006), The Gerontologist)

• Brief assessment of medication taking behavior using observation and interview to examine potential issues of compliance and medication management in the home.

• Consists of 20 items addressing:– Knowledge of medications– Appropriate administration– Knowledge of how to obtain refills.

• Psychometrics: – Cronbach’s alpha= .71– Test-retest: (intraclass correlation coefficient) ICC= 0.93. – Interrater reliability: ICC=0.74

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Medication Deficiency Checklist• Investigator developed

• Based on the literature, observations, and interview data

• List of possible errors related to medication preparation and administration– Response format: yes or no

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Sample CharacteristicsCaregivers (n=76)Gender: Race:Males: 22 (28.95%)White: 66 (86.84%)Females: 54 (71.05%) Non-white: 10 (13.16%)

Age: Mean = 67.38 yrs; Range = 42-93 yrsEducation: Mean = 14.97 yrs; Range = 9-30 yrsCo-morbidities: Mean = 6.81; Range = 1-17Relationship to patient:

Spouse:45 (59.21%) Other: 6 (7.91%)Child: 25 (32.89%)

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Gender: Race:

Males: 31 (40.79%)White: 66 (86.84%)

Females: 45 (59.21%) Non-white: 10 (13.16%)

Age: Mean = 80.07 yrs; Range = 60-97 yrs

Education: Mean = 13.45 yrs; Range = 3-22 yrs

Co-morbidities: Mean = 8.53; Range = 1-20

Sample CharacteristicsPatients (n=76)

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Summary Statistics: Instruments

• Newest Vital Sign– Mean = 4.08; Range = 0.00 - 6.00; SD =

1.81

• MedMAIDE– Mean = 0.69; Range = 0.00 - 2.00; SD =

0.71

• Medication Deficiency Checklist– Mean = 2.80; Range = 0.00 - 8.00; SD =

1.75

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Associations•Health Literacy

– Age: -0.38 (p=.00)– Education: 0.38 (p=.00)– Med. Deficiencies: 0.20 (p=.10)

•Co-morbidities– Age: 0.23 (p=.05)– Med. Deficiencies: 0.27 (p=.02)

•All other associations were not statistically significant

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Conclusions

• Caregivers with higher health literacy were younger and had more education.

• Fewer medication deficiencies were seen among older caregivers

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Limitations

• Only baseline data

• Small sample size

• Limited diversity within the sample

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Implications• There is a need to assess health literacy and

understanding of instructions

• Health care providers cannot assume that caregivers with adequate health literacy will be able to correctly follow instructions when managing medications of family members