Confused older patients die sooner: study

WASHINGTON Mon Jul 23, 2007 6:21pm EDT

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WASHINGTON (Reuters) - Understanding doctors' orders can be a matter of life or death for senior citizens: those who had trouble comprehending their physicians died sooner than their more savvy peers, U.S. researchers said on Monday.

Medicare clients who were confused by pill bottles or appointment slips were 52 percent more likely to die over the six years of the study, especially from heart disease.

"Patients with inadequate literacy know less about their diseases ... They are much more likely to be hospitalized," said Dr. David Baker of Northwestern University, who led the research.

"It's not just higher hospital rates. It's significantly higher mortality."

Baker and colleagues followed 3,260 Medicare patients 65 and older in four U.S. cities. To test the volunteers' so-called health literacy, which drops with age, they quizzed them on how well they understood prescription bottles, appointment slips and insurance forms.

"(We provided) a prescription bottle that says 'take this medicine on an empty stomach one hour before meals or two hours after.' The question is, you're going to eat lunch at noon, what time are you going to take this medicine?" Baker said in a telephone interview.

In another example: "Normal blood sugar is 80 to 130. Your blood sugar today is 160. Is your blood sugar normal? A quarter of patients couldn't get this correct," Baker said.

The 25 percent of people who got 55 percent or fewer of the questions right were rated as having inadequate health literacy. Another 11 percent scored as marginally literate and had a 13 percent higher chance of dying in the six years.

The findings held regardless of factors such as income and education, the researchers reported in the Archives of Internal Medicine.

Baker said he was not surprised that less literate patients were more vulnerable to death from heart disease -- which puts more burden on the patient to maintain their health.

"If somebody has heart problems or they have diabetes or high blood pressure, there's a whole host of things they need to be able to do to have good health in the future -- take medicines correctly, eat a low salt diet, exercise regularly," he said.

'EFFECTIVE COMMUNICATION'

Cancer patients are more intensively managed by health-care staff and may not need to be as personally involved in their own care, which may explain why health literacy did not affect their fates.

Dr. Anne Fabiny, chief of geriatrics at Cambridge Health Alliance in Massachusetts, said one of her patients made repeated trips to the emergency room when she felt dizzy from taking her daily blood pressure pills in one sitting.

The solution itself was easy: space out the doses over each day. The challenge was making sure her patient understood.

Many doctors do not check that their elderly patients can see or hear instructions in the first place, she added.

"I write out all my instructions for all my patients now (and) have them read the instructions back. If they can read it, (I ask) does that make sense to you?" Fabiny said in a telephone interview.

"Until physicians are compensated for the time it requires to have this sort of effective communication, it will continue to be a problem."

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