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Self‐Management Behaviors in Older Adults with Asthma: Associations with Health Literacy
Author(s) -
Federman Alex D.,
Wolf Michael S.,
Sofianou Anastasia,
Martynenko Melissa,
O'Connor Rachel,
Halm Ethan A.,
Leventhal Howard,
Wisnivesky Juan P.
Publication year - 2014
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12797
Subject(s) - medicine , health literacy , asthma , inhaler , dry powder inhaler , odds ratio , confidence interval , specialty , metered dose inhaler , literacy , cohort , health care , physical therapy , family medicine , economics , economic growth
Objectives To examine self‐management behaviors, including medication adherence and inhaler technique, in older adults with asthma and their association with health literacy. Design Observational cohort study. Setting Primary care and pulmonary specialty practices in two tertiary academic medical centers and three f ederally q ualified h ealth c enters in N ew Y ork, N ew Y ork, and C hicago, I llinois. Participants Adults with moderate or severe persistent asthma aged 60 and older ( N = 433). Measurements Outcomes were adherence to asthma controller medications, metered dose inhaler ( MDI ) and dry powder inhaler ( DPI ) techniques, having a usual asthma physician, and avoidance of four common triggers. Health literacy was assessed using the S hort T est of F unctional H ealth L iteracy in A dults. Results The mean age was 67, and 36% of participants had marginal or low health literacy. Adherence was low (38%) overall and worse in individuals with low health literacy (22%) than in those with adequate literacy (47%, P < .001) and after adjusting for demographic factors and health status (odds ratio (OR) = 0.48, 95% confidence interval ( CI ) = 0.31–0.73). Similarly, inhaler technique was poor; only 38% and 54% had good MDI and DPI technique, respectively. Technique was worse in those with low health literacy ( MDI technique: OR = 0.57, 95% CI = 0.38–0.85; DPI technique: OR = 0.42, 95% CI = 0.25–0.71). Asthma self‐monitoring and avoidance of triggers occurred infrequently but were less consistently associated with low health literacy. Conclusion Adherence to medications and inhaler technique are poor in older adults with asthma and worse in those with low health literacy. Clinicians should routinely assess controller medication adherence and inhaler technique and use low‐literacy communication strategies to support self‐management in older adults with asthma.