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School of Nursing
Health Literacy AmongInformal Caregivers of Persons With Memory Loss Judith A. Erlen, PhD, RN, FAAN; Jennifer H. Lingler, PhD, RN; Lisa K. Tamres, MS; Kidane B. Ghebrehawariat, MS; and Susan M. Sereika, PhD
University of Pittsburgh School of NursingSupported by NIH NINR P01NR010949
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Acknowledgements• Supported by NIH NINR P01NR010949 • Patients and their caregivers• Research Staff• Students• Community Advisory Board• Community liaisons
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Background• Caregivers of persons with memory loss face
increasing challenges over time
• Medication management is one such issue
• Of concern is the caregivers’ level of understanding of medication management
• Assessing health literacy is important
• Research describing the relationship between health literacy and correct medication management is limited
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Purpose
• To examine the relationships among
selected demographic variables, medication
taking deficiencies, and health literacy in a
sample of family caregivers of persons with
memory loss
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Methods: Overall Study• RCT designed to increase problem
solving related to medication management– Recruited patients with memory loss and
their informal caregivers from multiple community sites
– Eligible dyads were randomized to intervention and control following baseline data collection
– Intervention dyads were randomly assigned to either a nurse or a social worker
– All interventions and data collections occurred in the home or via telephone
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Methods: Current Study•Descriptive study
– Used baseline data •Analysis: •Descriptive statistics of caregiver and
patient data– Spearman correlation coefficient to
examine relationships
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Variables of Interest• Sociodemographic characteristics
– Gender, age, race, education, relationship to patient
• Number of co-morbidities• Health literacy
– Newest Vital Sign (NVS)• Medication errors
– Medication Management Instrument for Deficiencies in the Elderly (MedMAIDE)
– Medication Deficiency Checklist
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Newest Vital Sign (NVS)(Weiss et al (2005), Annals of Family Medicine)
• A brief health literacy screening instrument – uses a nutrition label accompanied by 6 questions – assesses numeracy and comprehension.
• Administration time is about 3 minutes. • NVS psychometrics:
– Cronbach’s alpha= .76– Correlates with the TOFHLA (r= 0.59, p< .001)
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Medication Management Instrument for Deficiencies in the Elderly (MedMAIDE)(Orwig et al (2006), The Gerontologist)
• Brief assessment of medication taking behavior using observation and interview to examine potential issues of compliance and medication management in the home.
• Consists of 20 items addressing:– Knowledge of medications– Appropriate administration– Knowledge of how to obtain refills.
• Psychometrics: – Cronbach’s alpha= .71– Test-retest: (intraclass correlation coefficient) ICC= 0.93. – Interrater reliability: ICC=0.74
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Medication Deficiency Checklist• Investigator developed
• Based on the literature, observations, and interview data
• List of possible errors related to medication preparation and administration– Response format: yes or no
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Sample CharacteristicsCaregivers (n=76)Gender: Race:Males: 22 (28.95%)White: 66 (86.84%)Females: 54 (71.05%) Non-white: 10 (13.16%)
Age: Mean = 67.38 yrs; Range = 42-93 yrsEducation: Mean = 14.97 yrs; Range = 9-30 yrsCo-morbidities: Mean = 6.81; Range = 1-17Relationship to patient:
Spouse:45 (59.21%) Other: 6 (7.91%)Child: 25 (32.89%)
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Gender: Race:
Males: 31 (40.79%)White: 66 (86.84%)
Females: 45 (59.21%) Non-white: 10 (13.16%)
Age: Mean = 80.07 yrs; Range = 60-97 yrs
Education: Mean = 13.45 yrs; Range = 3-22 yrs
Co-morbidities: Mean = 8.53; Range = 1-20
Sample CharacteristicsPatients (n=76)
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Summary Statistics: Instruments
• Newest Vital Sign– Mean = 4.08; Range = 0.00 - 6.00; SD =
1.81
• MedMAIDE– Mean = 0.69; Range = 0.00 - 2.00; SD =
0.71
• Medication Deficiency Checklist– Mean = 2.80; Range = 0.00 - 8.00; SD =
1.75
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Associations•Health Literacy
– Age: -0.38 (p=.00)– Education: 0.38 (p=.00)– Med. Deficiencies: 0.20 (p=.10)
•Co-morbidities– Age: 0.23 (p=.05)– Med. Deficiencies: 0.27 (p=.02)
•All other associations were not statistically significant
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Conclusions
• Caregivers with higher health literacy were younger and had more education.
• Fewer medication deficiencies were seen among older caregivers
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Limitations
• Only baseline data
• Small sample size
• Limited diversity within the sample
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Implications• There is a need to assess health literacy and
understanding of instructions
• Health care providers cannot assume that caregivers with adequate health literacy will be able to correctly follow instructions when managing medications of family members