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Health Literacy, Adherence and Access To Benefits
1. Health Literacy,
Adherence & Access
to Benefits
Older Adults, HIV and Online Resources webinar series
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Alanna Costelloe-Kuehn, Health Specialist
Older Adults Technology Services (OATS)
Supported by ACRIA
2. Agenda
• Impact of health literacy
• Promoting health literacy among older adults
• Benefits for older adults with HIV
• Online resources
3. HIV and Aging
• By 2030 the proportion of the US population
aged 65 and older will double from 39 million to
about 71 million
• People living with HIV are living longer with a
diverse array of aging related conditions
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4. Communication
• Many clinicians do not ask older patients about
their sexual activity
– Only 38% of older men and 22% of older women
reported discussing sex life with health care providers
– Silence and stigma of homosexuality in older adults
may limit honest patient-doctor conversations
• Lack of prevention programs geared towards
older persons and physician comfort levels with
geriatric patients in discussing sexuality
5. What is Health Literacy?
“… the capacity to obtain, process,
and understand basic health
information and services needed to
make appropriate health decisions.”
- Health Literacy: A Prescription to End Confusion The
Institute of Medicine, 2004
6. Health literacy bridges
knowledge and behavior
• Health literacy includes being able
to understand instructions on:
– prescription bottles
– appointment slips
– health education brochures
– doctor’s instructions
– consent forms
7. Poor Health Literacy
• Poor adherence to prescription
instructions
• Infrequent use of preventive medical
services
• Increased hospitalizations
• Increased visits to the emergency room
• Overall worse control of chronic diseases
8. Health Literacy For Older Adults
• Adults age 63 and older have lower health
literacy scores than all other age group
• Only 3% of older adults surveyed had
proficient health literacy skills
The 2003 National Assessment of Adult Literacy
9. Complications in Older Adults
• Multiple conditions
• Many, many medications
• Talking to doctors
• Internet comfort levels
10. • Had lower levels of HIV knowledge
• Misconceptions of HIV transmission,
HIV viral loads, CD4 cell counts
• Less likely to have an undetectable HIV viral load
A Multifaceted Adaptive Testing Approach to Health Literacy
in Older Adults David R. Kaufman, PhD, Columbia University
Health Sciences, National Institute of Nursing Research
Lower HIV Health Literacy
Older adults living with HIV/AIDS
with lower levels of health literacy:
11. Prescription Labels and Adherence
• Comorbidities complicate
treatment adherence and drug
interactions
• Adherence is higher among older
adults
• Up to 40% of older patients who
decided to skip doses or stop
taking their medicine do not tell
their provider
• Older adults may not
adhere to drug
regimens due to
– Forgetfulness
– Side effects
– Perceived non-efficacy
– Cost
12. Health literacy goes beyond
the individual…
It also depends upon the skills, preferences, and
expectations of those health information providers:
our doctors, nurses, administrators, home health
workers, the media, and many others
Access + Utilization =
Health Literacy
13. Building Older Adults’ Health
Literacy Online
• Bridge digital divide
• Increase confidence
• Increase knowledge of health conditions
and healthy lifestyles
• Help people know how to talk to doctors
• Increase skills in evaluating health
information resources
14. Older Adults & the Internet
Demographics of Internet Users, July 2009
15. What About the Boomers?
• In 2 years, boomers will begin to age into
the 65+ demographic
• Higher Internet skills
• Health seeking online is one of the only
areas that boomers dominate over other
generations
• Younger baby boomers are most likely to
have searched online for prescription drug
information
17. Ask Me 3
1.What is my main problem?
2.What do I need to do?
3.Why is it important for me to do this?
http://www.npsf.org/askme3/
18. Medical Library Association
• Reliable Sources of Health Information
• Your Medicine: Play it Safe
• Medicine Record Form
• Buying Prescription Medicine Online:
A Consumer Safety Guide
http://www.mlanet.org/resources/consumr_index.html#senior
19. National Institute on Aging
• Database of more than 300
national organizations that
provide help to older adults
• Age Page: HIV, AIDS, and Older People
20. MedlinePlus.gov
• Health Topics for Seniors
• Introductory information about HIV/AIDS
• Easy-to-read articles
• Medical dictionary
• Medical encyclopedia with large
illustrations
• Links to local services
MedlinePlus.gov
21. Video Tutorials on
MedlinePlus
• MedlinePlus.gov also hosts
information in the form of
accessible video tutorials on
a wide range of conditions
including HIV/AIDS
28. Online PHR
• Online Personal Health Record (PHR)
• Holds information about conditions, medications
(including interactions), allergies, doctors, etc.
• Google Health -- free and easy-to-use online
PHR
health.google.com
29. Adherence Tools
• Calendar reminders can be used to improve
adherence
– Google Calendar (calendar.google.com)
• Cell phone application
– Pill Phone (www.pillphone.com)
– Pillboxer (www.pillboxer.com)
• Cell phone alarms
• POZ combo cards (www.combocards.com)
30. Benefits For Older Adults Living With HIV
• Older Americans Act
• Medicare
• Medicaid
• Social Security
• Department of Veterans
Affairs
• Ryan White CARE Act
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32. Older Americans Act
• Provides state service programs
– 629 area agencies on aging
– Nearly 20,000 service providers
• Eligibility begins at 60
• The Act indicates the importance of meeting the
needs of specific vulnerable populations
– Neither LGBT elders nor HIV-positive older adults are
explicitly listed as vulnerable populations.
33. Medicare
• Qualify by age or 2
years of Social
Security Disability
• Provides crucial
medical coverage for
people living with HIV
and low-income
elderly people
• Health insurance
program for people
who are 65 and over
• 34 million people
covered through
Medicare
Medicare Interactive Website (www.medicareinteractive.org)
34. Medicaid
• Health care for
– disabled
– low-income children
and their parents
– medically needy
• Finances health
coverage for more
than 59 million
people
• Covers most elderly
Americans, many living
with HIV and AIDS
• Guidelines for eligibility
and benefits by state
35.
36. Social Security
• 65% (15 million) of adults over 65 rely on social
security for half their income
• 33% rely on social security for over 90% of their
income
• Same-sex partners not eligible
• Supplemental Security Income
– Provides a safety-net for people living with HIV who
qualify as disabled
– Medical evidence for HIV infection
(www.ssa.gov/disability/professionals/hiv-pub037.htm)
• Social Security FAQ (www.ssa.gov/pubs/10019.html)
• Find local Social Security office (www.ssa.gov/regions/)
37. Department of
Veterans Affairs
• Largest single
provider of
medical care to
people with HV
• VA medical facilities:
– Screening
– Testing
– Education
– Clinical care
38. HIV-specific Healthcare &
Senior Service Programs
• Ryan White CARE Act
– Established to meet the health care needs of
people living with HIV
– $2.3 billion budget
• Minority AIDS Initiative (MAI)
• Housing Opportunities for People with
AIDS (HOPWA)
39. Online Resources
• HITE Site for Services
– http://www.hitesite.org/
– Health Information Tool for Empowerment
• ACCESS NYC
– https://a858-
ihss.nyc.gov/ihss1/en_US/IHSS_homePage.do
– Check on benefits eligibility,
including city, state, and federal benefits
• Community Health Advocates
– www.communityhealthadvocates.org/
– Assists consumers, communities, and social service
organizations in navigating NY’s health care systems
40. New York City Department
for the Aging
• Senior Services by borough
or by service
• Housing Finder Tool for
Older Adults
http://www.nyc.gov/html/dfta/html/home/home.shtml
44. Upcoming Webinars
Accessing and Using Social Media
Thursday, March 3rd at 12pm
The Aging HIV Population
Thursday, March 10th at 3pm
Visit www.seniorplanet.org/olderadultshiv for full
webinar schedule
45. Discussion
• To ask a question you can:
– Ask by audio
– Send you question via chat
– Email your question to health@oats.org
• This webinar and the rest of the series will be
available to download at
www.seniorplanet.org/olderadultshiv
