Vice President Business Development Powerback Rehabilitation Chicago, Illinois, United States
Disclosure(s):
Jordan J. Bowman, M.A. CCC-SLP: No financial or non-financial relationships to disclose
Abstract: This seminar aims to inspire Speech-Language Pathologists to take an active role in the early identification of health literacy skills of patients with mild cognitive impairment for enhanced patient resiliency and sustainable outcomes. Evidence-based treatment interventions for improved cognitive-communication will be examined. Considerations for health literacy interventions including enhancing access to care, comprehension of health information, and interpretation and evaluation of health information will be explored. Finally, SLPs will examine the role of the caregiver in improving health literacy and patient outcomes for reduced risk of rehospitalizations.
Summary of Presentation : Health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (U.S. Department of Health and Human Services, 2010). When health literacy is adequate in individuals, including older adults, the ability to make appropriate health decisions positively impacts patients' health outcomes (Lee & Son, 2018), reduces the risk of emergency room visits (Cho, Lee, Arozullah, & Crittenden, 2008), and reduces the risk of hospitalization.
“The relationship between an increasing elderly population and wide-ranging neurological conditions has led to heightened rates of cognitive function impairment” (Liu, Chen, Xue, & Hou, 2019, p. 433). Older adults with mild cognitive impairment (MCI), defined as cognitive decline greater than expected for an individual's age and education level but that does not interfere notably with activities of daily life (Gauthier, et, al., 2006) are at risk for low health literacy and poorer health outcomes (Bennett, Bennett, Boyle, & James, 2012). A combination of MCI and low health literacy places these individuals at substantial risk for faster disease progression (Kaphingst, Goodman, MacMillan, Carpenter, & Griffey, 2014), mismanagement of chronic health conditions (Lee & Son, 2018), frequent hospitalizations (Cho, et al., 2008), and increased health care costs (Bennett, et al., 2012). Kaphingst, et al. (2014) suggest “older patients with cognitive dysfunction have the greatest need for health literacy interventions.”
There are several factors associated with low health literacy in older adults with MCI. In MCI, basic health literacy skills are affected by cognitive dysfunction including dysfunction of memory and executive function (Rostamzadeh, Stapels, Genske, Haidl, Jünger, Seves, Woopen, & Jessen, 2020). Speech-Language Pathologists (SLPs) have the unique skills to identify subtle changes in cognitive function and utilize evidenced-based treatment interventions to improve memory and executive function in patients with MCI (Bayles, McCullough, & Tomoeda, 2018). Education, age, race, income (Kutner, Greenburg, Jin, & Paulsen 2006), social activity, and physical activity (Bennett, et al., 2012) also influence literacy and health literacy in the older adult. Additionally, the health literacy skills of caregivers of adults with cognitive impairment affect the individual’s ability to access and make decisions about health information (Jiang, Sereika, Linger, Tamres, & Erlen, 2018). Identifying these risk factors as part of a comprehensive patient interview can help the SLP to identify patients at risk for low health literacy and poor patient outcomes.
Liu et al. (2019, p. 434) encourage “For healthcare professionals, screening for health literacy risk should be included in multidimensional geriatric evaluation.” Objective health literacy screening measures such as the Newest Vital Sign (Weiss, Mays, Martz, Castro, DeWalt, Pignone, Mockbee, & Hale, 2005) and The Short Assessment of Health Literacy (Shoou-Yih, Stucky, Lee, Rozier, & Bender 2010) are just two examples of easily accessible tools that provide meaningful information to the SLP and the interprofessional team treating the older adult with MCI. SLPs can incorporate these types of screening tools into their comprehensive evaluation process to identify patient-specific risk factors as well as opportunities for treatment interventions. Attention to the caregiver’s health literacy skills is also paramount. Jiang, et al. (2018) suggest limited health literacy is an issue among caregivers of adults with memory loss and that assessment and person-centered support are also crucial for caregivers who are at risk for poor health literacy.
Evidenced-based treatment interventions designed to improve global cognitive-linguistic function in the patient with MCI include cognitive stimulation programs (Gómez-Soria, Peralta-Marrupe, Calatayud-Sanz, & Latorre 2021), training in compensatory strategies, training in the use of memory aids (Bayles et al., 2018), and most recently, mindfulness techniques (Wells et al., 2019). SLPs can utilize these techniques as well as caregiver training in the treatment of MCI. Although research suggests improved cognition may positively impact health literacy (Lee & Son, 2018), direct functional interventions and considerations designed to facilitate patient access to care, patient comprehension of health information, patient decision-making, and caregiver training must also be incorporated to achieve sustainable patient outcomes. In addition, Bennet et al. (2012) raise the possibility that improvements in health literacy and cognitive function in older adults may also lead to better physical and mental health, more efficient use of financial services, increased self-sufficiency, and lower health care costs.
In order for the patient to sustain the positive outcomes achieved during the SLP’s therapeutic interventions, the caregiver’s health literacy level, communication style, and ability to support the patient with MCI must be considered. Moreover, patient-specific health information must be redesigned to be more accessible, understandable, and relevant to both the patient and the patient’s caregiver (Liu, et al., 2019). The caregiver plays a crucial role in ensuring the patient maintains both learned cognitive-linguistic and health literacy skills. Educating and empowering both the patient and the caregiver through health literacy interventions promotes personal resilience and sustainable outcomes.
Learning Objectives:
At the completion of this activity, participants should be able to:
Identify factors that limit health literacy in the patient with mild cognitive impairment
Develop person-centered treatment plans incorporating both cognitive-communication strategies and health literacy interventions
Describe the caregiver’s role in supporting the patient with low health literacy and mild cognitive impairment for sustainable patient outcomes and reduced risk of rehospitalizations