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Literacy Mediates Racial Differences in Financial and Healthcare Decision Making in Older Adults
Author(s) -
Han S. Duke,
Barnes Lisa L.,
Leurgans Sue,
Yu Lei,
Bennett David A.,
Boyle Patricia A.
Publication year - 2020
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.16381
Subject(s) - medicine , health literacy , gerontology , financial literacy , health care , literacy , health and retirement study , demography , psychology , finance , economics , economic growth , pedagogy , sociology
BACKGROUND/OBJECTIVES Decision making in financial and healthcare matters is of critical importance for well‐being in old age. Preliminary work suggests racial differences in decision making; however, the factors that drive racial differences in decision making remain unclear. We hypothesized literacy, particularly financial and health literacy, mediates racial differences in decision making. DESIGN Community‐based epidemiologic cohort study. SETTING Communities in northeastern Illinois. PARTICIPANTS Nondemented Black participants (N = 138) of the Rush Alzheimer's Disease Center Minority Aging Research Study and the Rush Memory and Aging Project who completed decision‐making and literacy measures were matched to White participants (N = 138) according to age, education, sex, and global cognition using Mahalanobis distance (total N = 276). MEASUREMENTS All participants completed clinical assessments, a decision‐making measure that resembles real‐world materials relevant to finance and healthcare, and a financial and health literacy measure. Regression models were used to examine racial differences in decision making and test the hypothesis that literacy mediates this association. In secondary analyses, we examined the impact of literacy in specific domains of decision making (financial and healthcare). RESULTS In models adjusted for age, education, sex, and global cognition, older Black adults performed lower than older White adults on literacy (β = −8.20; SE = 1.34; 95% CI = −10.82 to −5.57; P < .01) and separately on decision making (β = −.80; SE = .23; 95% CI = −1.25 to −.34; P < .01). However, when decision making was regressed on both race and literacy, the association of race was attenuated and became nonsignificant (β = −.45; SE = .24; 95% CI = −.93 to .02; P = .06), but literacy remained significantly associated with decision making (β = .04; SE = .01; 95% CI = .02‐.06; P < .01). In secondary models, a similar pattern was observed for both financial and healthcare decision making. CONCLUSIONS Racial differences in decision making are largely mediated by literacy. These findings suggest that efforts to improve literacy may help reduce racial differences in decision making and improve health and well‐being for diverse populations. J Am Geriatr Soc 68:1279–1285, 2020.