Comprehension of written health care information in an affluent geriatric retirement community: use of the Test of Functional Health Literacy

Gerontology. 2002 Mar-Apr;48(2):93-7. doi: 10.1159/000048933.


Background: The comprehension of written health care information, e.g. prescription bottle labels or an informed consent form, impacts on communication with patients and their ability to understand medical procedures, as well as goals of therapy.

Objective: To determine if the problem of literacy was present in a population of affluent Albuquerque retirement community dwellers.

Methods: We administered the Test of Functional Health Literacy in Adults (TOFHL) to 93 residents (71 women and 22 men), using a one-on-one directed examination conducted by one of the authors (J.G.B.).

Results: The group studied had a mean age of >70 years, were not acutely ill, had no known loss of mental function, were better educated and had a high standard of living compared to national standards. However, 30% (95% confidence level) of our group were unable to adequately comprehend written information as measured by the TOFHL. The subgroup with poor comprehension (21 women and 7 men) had a mean age of 85 years (versus 82 years in the group with good comprehension) and a mean of 13 years (versus 15 years in the group with good comprehension) of formal education. Multivariate analysis was consistent with a negative effect of age (p = 0.04), a positive effect of years of formal education (p = 0.0005) and no effect of gender on the TOFHL score.

Conclusion: Two recent studies, one in an emergency room setting and the other among Medicare enrollees, demonstrated similar results to ours. The high prevalence of poor comprehension in these groups should alert providers to the need to develop additional or different communication skills that can address the problem of poor reading comprehension across at least three diverse groups of people, with particular attention to those over the age of 65.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cognition*
  • Delivery of Health Care
  • Educational Measurement / methods
  • Educational Status*
  • Female
  • Health Education*
  • Humans
  • Income*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Patient Education as Topic*
  • Reading*
  • Retirement*