What You Can't Read Can Kill You

July 24, 2007 — -- Mabel Hoffman has a routine when she goes to the doctor.

"I always take a pencil and paper with me, because it's hard to remember certain things," she said. "I also take my husband or my daughter with me to help me remember and ask questions."

Hoffman, 79, is one of the millions of aging Americans who work hard to stay healthy and keep medical instructions straight.

A new study, released Monday in the journal Archives of Internal Medicine, suggests that elderly people who can't navigate health information have a 50 percent higher chance of dying earlier than those who are able to comprehend prescription bottles, doctor appointment slips and hospital forms.

"People are dying because they're not understanding health information," said Dr. David Baker, the study's lead author. "There are a number of factors, but inadequate literacy is probably acting like a lens, focusing all the other factors in."

The researchers at Northwestern University interviewed 3,260 Medicare patients ages 65 and older. They asked the patients about their ethnicity, education, income, health behaviors and medical conditions. Then, the patients took tests designed to assess their health literacy.

Five years later, the reviewers determined which patients had died by matching their names against the National Death Index.

They found that low health literacy was a strong predictor for early death, second only to smoking, surpassing income level and years of education.

"These people are less likely to know what their diseases are and less likely to know how to take care of themselves," Baker said. "They're more likely to be hospitalized. Eventually, the low literacy is going to affect their health." Baker thinks this is why they are much more likely to die.

According to the 2003 National Assessment of Adult Literacy, more than 75 million Americans have only basic or below basic health literacy. The National Academy on Aging Society estimated that the inability to understand medical directions costs more than $73 billion in health costs per year.

Help for Health Literacy

"Health literacy is a problem I see every day in my practice," said Dr. Sharon Brangman, professor of geriatric medicine at the State University of New York's Upstate Medical University.

"Many of my patients did not complete school; they dropped out to work and help their families during the Depression," she said. "Even those who are educated don't want their doctors to use three- or four-syllable words when they're sick."

Brangman asks her patients to bring in all the medications they are taking to their appointments in the clinic. "If they tell me they take a little white pill, and they don't know anything more than that, it can be dangerous."

She also says it's important for health-care providers to speak in plain language. "I gave one of my patients a book — 'You and Essential Hypertension.' He had no idea what that meant. All he knew was that he had high blood pressure."

Because of elderly patients like these, health-care providers at Brangman's office work to translate written information into jargon-free materials.

Baker agrees that such resources are needed.

"The first thing we need to do is communicate with people in plain language," he said. "We need to find words in plain English, both spoken and written."

For example, Baker says that using sugar instead of glucose when discussing diabetes can help patients understand their condition more easily.

Baker also says the old maxim "a picture is worth a thousand words" rings especially true when it comes to older patients.

"Complicated ideas can be explained very simply using pictures or video," he said. "For example, there are complex steps to taking an inhaler; the process could be simplified with a picture."

Say It Once, Say It Again

Both Brangman and Baker agree that repetition is key.

"I always ask patients to repeat back what I've said," Brangman said. "When someone is getting a scary diagnosis, they go into anxiety mode and stop listening. So, we have to spend more time with people, to make sure they've gotten the message."

Bringing a family member to help ask questions and jot down notes can also help, Brangman says.

Hoffman has another technique: She sometimes calls the nurse or pharmacist and asks a lot of questions.

And for now, she understands how to manage her health.

"Of course, if people don't know what medication they are taking, or they take too much of it, they can have a reaction — it's a mess," Hoffman said.

"I'm sticking to my doctors — whatever they tell me to do, I do."