Impact of Health Literacy on Frailty among Community-Dwelling Seniors
Abstract
:1. Introduction
2. Experimental Section
2.1. Study Design
2.2. Measures
2.3. Statistical Analysis
3. Results
3.1. Characteristics of the Participants
3.2. Relationships among Health Literacy, Pre-Frailty, and Frailty
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Characteristics | Total (n = 603) | Men (n = 296) | Women (n = 307) | p Value * |
---|---|---|---|---|
Age, years (mean ± standard deviation [SD]) | 70.9 ± 5.82 | 72.04 ± 6.45 | 69.81 ± 4.90 | <0.001 |
BMI, kg/m2 (mean ± SD) | 24.67 ± 2.99 | 24.52 ± 2.84 | 69.81 ± 4.10 | 0.23 |
Education level, n (%) | ||||
Illiterate | 128 (21.23%) | 43 (14.53%) | 85 (27.69%) | <0.001 |
Elementary school | 299 (49.59%) | 146 (49.32%) | 153 (49.84%) | |
Junior and senior high school | 130 (21.56%) | 70 (23.65%) | 60 (19.54%) | |
College or above | 46 (7.63%) | 37 (12.5%) | 9 (2.93%) | |
Health literacy, n (%) | ||||
Inadequate | 135 (22.4%) | 65 (22.0%) | 70 (22.8%) | 0.004 |
Problematic | 204(33.83%) | 104 (35.14%) | 100 (32.57%) | |
Sufficient | 176 (29.19%) | 71 (24%) | 105 (34.2%) | |
Excellent | 88 (14.59%) | 56 (18.92%) | 32 (10.42%) | |
Annual income, n (%) | ||||
No income | 46 (7.63%) | 17 (5.74%) | 29 (9.45%) | 0.08 |
≤8000 USD | 389 (64.51%) | 187 (63.18%) | 202 (65.8%) | |
>8000 USD | 168 (27.86%) | 92 (31.08%) | 76 (24.75%) | |
Multiple comorbidities, No. of diseases (%) | ||||
0–2 | 521 (86.4%) | 257 (86.82%) | 264 (86%) | 0.77 |
≥3 | 82 (13.6%)) | 39 (13.18%) | 43 (14%) | |
Polypharmacy, No. of medications (%) | ||||
<5 | 183 (30.35%) | 93 (31.42%) | 90 (29.32%) | 0.57 |
≥5 | 420 (69.65%) | 203 (68.58%) | 217 (70.68%) | |
GDS-5 score | ||||
<2 | 483 (80.1%) | 238 (80.41%) | 245 (79.8%) | 0.85 |
≥2 | 120 (19.9%) | 58 (19.59%) | 62 (20.2%) | |
Physical activity (IPAQ), n (%) | ||||
Insufficiently active | 281 (46.6%) | 132 (44.59%) | 149 (48.53%) | 0.02 |
Sufficiently active | 284 (47.1%) | 137 (46.28%) | 147 (47.88%) | |
Highly active | 38 (6.3%) | 27 (9.12%) | 11 (3.58%) | |
Calorie intake, kcal/kg/day (mean ± SD) | 20.25 ± 4.97 | 19.97 ± 4.36 | 20.51 ± 5.48 | 0.18 |
Macronutrients | ||||
Carbohydrate intake, g/kg/day | 3.01 ± 0.85 | 2.97 ± 0.78 | 3.06 ± 0.92 | 0.17 |
Fat intake, g/kg/day | 0.61 ± 0.2 | 0.61 ± 0.18 | 0.62 ± 0.21 | 0.3 |
Protein intake, g/kg/day | 0.66 ± 0.19 | 0.66 ± 0.17 | 0.67 ± 0.20 | 0.87 |
Walking speed, m/s (mean ± SD) | 1 ± 0.2 | 1.03 ± 0.17 | 0.97 ± 0.22 | <0.001 |
Handgrip, kg (mean ± SD) | 23.46 ± 7.74 | 28.14 ± 7.45 | 18.95 ± 4.75 | <0.001 |
Frailty status, n (%) | ||||
Robust | 271(44.94%) | 138 (46.62%) | 133 (43.32%) | 0.18 |
Pre-frailty | 314 (52.07%) | 146 (49.32%) | 168 (54.72%) | |
Frailty | 18 (2.99%) | 12 (4.05%) | 6 (1.95%) |
Characteristics | Inadequate HL (n = 135) | Problematic HL (n = 204) | Sufficient HL (n = 176) | Excellent HL (n = 88) | p Value * |
---|---|---|---|---|---|
Age, years (mean ± SD) | 73.2 ± 6.1 | 71.1 ± 6.1 | 70.0 ± 4.9 | 68.5 ± 5.0 | <0.001 |
BMI, kg/m2 (mean ± SD) | 24.6 ± 3.1 | 24.7 ± 3.2 | 24.8 ± 2.9 | 24.4 ± 2.4 | 0.71 |
Education level, n (%) | |||||
Illiterate | 56 (41.5%) | 46 (22.5%) | 23 (13.1%) | 3 (3.4%) | <0.001 |
Elementary school | 68 (50.4%) | 126 (61.8%) | 86 (48.9%) | 19 (21.6%) | |
Junior and senior high school | 11 (8.1%) | 30 (14.7%) | 63 (35.8%) | 26 (29.5%) | |
College-or-above | 0 | 2 (1.0%) | 4 (2.3%) | 40 (45.5%) | |
Annual income, n (%) | |||||
No income | 3 (2.2%) | 14 (6.9%) | 28 (15.9%) | 1 (1.1%) | <0.001 |
≤8000 USD | 83 (61.5%) | 152 (74.5%) | 110 (62.5%) | 44 (50.0%) | |
>8000 USD | 49 (36.3%) | 38 (18.6%) | 38 (21.6%) | 43 (48.9%) | |
Multiple comorbidities, No. of diseases (%) | |||||
0–2 | 99 (73.3%) | 178 (87.3%) | 159 (90.3%) | 85 (96.6%) | <0.001 |
≥3 | 36 (26.7%) | 26 (12.7%) | 17 (9.7%) | 3 (3.4%) | |
Polypharmacy, No. of medication (%) | |||||
<5 | 21 (15.6%) | 58 (28.4%) | 60 (34.1%) | 44 (50.0%) | <0.001 |
≥5 | 114 (84.4%) | 146 (71.6%) | 116 (65.9%) | 44 (50.0%) | |
GDS-5 scores | |||||
<2 | 80 (59.3%) | 165 (80.9%) | 156 (88.6%) | 82 (93.2%) | <0.001 |
≥2 | 55 (40.7%) | 39 (19.1%) | 20 (11.4%) | 6 (6.8%) | |
Physical activity (IPAQ), n (%) | |||||
Insufficiently active | 94 (69.9%) | 88 (43.1%) | 61 (34.1%) | 38 (43.2%) | <0.001 |
Sufficiently active | 38 (28.1%) | 100 (49.0%) | 101 (57.4%) | 45 (51.1%) | |
Highly active | 3 (2.2%) | 16 (7.8%) | 14 (8.0%) | 5 (5.7%) | |
Calorie intake, kcal/kg/day (mean ± SD) | 20.4 ± 4.6 | 20.4 ± 5.6 | 19.8 ± 4.9 | 20.4 ± 4.2 | 0.62 |
Macronutrients | |||||
Carbohydrate intake, g/kg/day | 3.0 ± 0.7 | 3.1 ± 1.0 | 3.0 ± 0.8 | 3.0 ± 0.8 | 0.56 |
Fat intake, g/kg/day | 0.6 ± 0.2 | 0.6 ± 0.2 | 0.6 ± 0.2 | 0.6 ± 0.2 | 0.17 |
Protein intake, g/kg/day | 0.7 ± 0.2 | 0.7 ± 0.2 | 0.6 ± 0.2 | 0.7 ± 0.2 | 0.23 |
Walking speed, m/s (mean ± SD) | 1.0 ± 0.2 | 1.0 ± 0.2 | 1.0 ± 0.2 | 1.1 ± 0.2 | <0.001 |
Handgrip, kg (mean ± SD) | 23.4 ± 6.5 | 23.3 ± 7.3 | 21.6 ± 8.4 | 27.8 ± 7.5 | <0.001 |
Frailty status, n (%) | |||||
Robust | 46 (34.1%) | 105 (51.5%) | 64 (36.4%) | 56 (63.6%) | <0.001 |
Pre-frailty | 84 (62.6%) | 93 (45.6%) | 106 (60.2%) | 31 (35.2%) | |
Frailty | 5 (3.7%) | 6 (2.9%) | 6 (3.4%) | 1 (1.1%) |
Pre-Frailty and Frailty (Versus Robust) | ||||||||
---|---|---|---|---|---|---|---|---|
Variable | Univariate Model | Multivariate Model * | ||||||
Odds Ratio | 95% CI | p Value | Odds Ratio | 95% CI | p Value | |||
Lower Limit | Upper Limit | Lower Limit | Upper Limit | |||||
Age (years) | 1.03 | 1.00 | 1.06 | 0.07 | 1.02 | 0.98 | 1.05 | 0.33 |
Sex | ||||||||
Female | 1.00 | 1.00 | ||||||
Male | 0.88 | 0.63 | 1.21 | 0.42 | 1.06 | 0.74 | 1.52 | 0.76 |
BMI (kg/m2) | 1.05 | 0.99 | 1.11 | 0.09 | 1.04 | 0.98 | 1.11 | 0.18 |
Education level | ||||||||
Illiterate | 2.84 | 1.42 | 5.71 | <0.01 | 1.66 | 0.65 | 4.24 | 0.29 |
Elementary school | 2.34 | 1.23 | 4.45 | 0.01 | 1.46 | 0.63 | 3.41 | 0.38 |
Junior/senior high school | 1.56 | 0.78 | 3.10 | 0.21 | 0.95 | 0.42 | 2.18 | 0.91 |
College or above | 1.00 | 1.00 | ||||||
Health literacy | ||||||||
Inadequate | 3.39 | 1.93 | 5.94 | <0.01 | 1.71 | 0.82 | 3.56 | 0.15 |
Problematic | 1.65 | 0.99 | 2.76 | 0.06 | 1.11 | 0.58 | 2.14 | 0.74 |
Sufficient | 3.06 | 1.80 | 5.21 | <0.01 | 2.51 | 1.32 | 4.77 | 0.01 |
Excellent | 1.00 | 1.00 | ||||||
Annual income | ||||||||
No income | 1.92 | 0.97 | 3.82 | 0.06 | 1.52 | 0.72 | 3.22 | 0.28 |
≤8000 USD | 1.14 | 0.79 | 1.64 | 0.48 | 0.99 | 0.65 | 1.51 | 0.96 |
>8000 USD | 1.00 | 1.00 | ||||||
Comorbidities (No. of diseases) | ||||||||
0–2 | 1.00 | 1.00 | ||||||
≥3 | 1.91 | 1.16 | 3.14 | 0.01 | 1.35 | 0.78 | 2.32 | 0.28 |
Polypharmacy (No. of medications) | ||||||||
<5 | 1.00 | 1.00 | ||||||
≥5 | 1.40 | 0.99 | 1.99 | 0.06 | 1.02 | 0.69 | 1.52 | 0.92 |
GDS-5 score | ||||||||
<2 | 1.00 | 1.00 | ||||||
≥2 | 1.92 | 1.26 | 2.93 | <0.01 | 1.58 | 0.99 | 2.52 | 0.053 |
Physical activity (IPAQ) | ||||||||
Insufficiently active | 1.47 | 1.06 | 2.03 | 0.02 | 1.55 | 1.07 | 2.23 | 0.02 |
Sufficiently/highly active | 1.00 | 1.00 | ||||||
Protein intake (g/kg/day) | ||||||||
<0.8 | 1.15 | 0.52 | 2.55 | 0.72 | 1.06 | 0.45 | 2.53 | 0.89 |
0.8–1 | 0.71 | 0.30 | 1.68 | 0.44 | 0.70 | 0.28 | 1.73 | 0.44 |
≥1 | 1.00 | 1.00 |
Pre-Frailty and Frailty (Versus Robust) | ||||||||
---|---|---|---|---|---|---|---|---|
Variable | Insufficiently Physically Active Category # | Sufficiently/Highly Physically Active Category * | ||||||
Odds Ratio | 95% CI | p Value | Odds Ratio | 95% CI | p Value | |||
Lower Limit | Upper Limit | Lower Limit | Upper Limit | |||||
Age (years) | 0.99 | 0.94 | 1.04 | 0.59 | 1.04 | 0.99 | 1.09 | 0.09 |
Sex | ||||||||
Female | 1.00 | 1.00 | ||||||
Male | 1.51 | 0.87 | 2.65 | 0.15 | 0.75 | 0.44 | 1.26 | 0.28 |
Body weight index [BMI] (kg/m2) | 1.02 | 0.92 | 1.13 | 0.68 | 1.11 | 1.02 | 1.21 | 0.02 |
Education level | ||||||||
Illiterate | 1.05 | 0.22 | 4.99 | 0.95 | 1.67 | 0.49 | 5.73 | 0.42 |
Elementary school | 1.90 | 0.45 | 7.95 | 0.38 | 0.79 | 0.26 | 2.39 | 0.67 |
Junior/senior high school | 1.13 | 0.29 | 4.49 | 0.86 | 0.62 | 0.21 | 1.86 | 0.39 |
College or above | 1.00 | 1.00 | ||||||
Health literacy | ||||||||
Inadequate | 5.44 | 1.60 | 18.45 | 0.01 | 0.56 | 0.19 | 1.69 | 0.31 |
Problematic | 2.62 | 0.81 | 8.51 | 0.11 | 0.73 | 0.32 | 1.68 | 0.46 |
Sufficient | 4.12 | 1.28 | 13.22 | 0.02 | 2.41 | 1.07 | 5.42 | 0.03 |
Excellent | 1.00 | 1.00 | ||||||
Annual income | ||||||||
No income | 5.44 | 1.01 | 29.17 | 0.048 | 0.98 | 0.37 | 2.57 | 0.96 |
≤8000 USD | 0.98 | 0.54 | 1.81 | 0.96 | 1.00 | 0.52 | 1.94 | 0.99 |
>8000 USD | 1.00 | 1.00 | ||||||
Multiple comorbidities (No. of diseases) | ||||||||
0–2 | 1.00 | 1.00 | ||||||
≥3 | 1.04 | 0.49 | 2.19 | 0.93 | 2.03 | 0.85 | 4.84 | 0.11 |
Polypharmacy (No. of medications) | ||||||||
<5 | 1.00 | 1.00 | ||||||
≥5 | 0.59 | 0.31 | 1.15 | 0.12 | 1.44 | 0.84 | 2.47 | 0.19 |
GDS-5 score | ||||||||
<2 | 1.00 | 1.00 | ||||||
≥2 | 1.63 | 0.82 | 3.25 | 0.17 | 1.71 | 0.86 | 3.41 | 0.13 |
Protein intake (g/kg/day) | ||||||||
<0.8 | 2.22 | 0.68 | 7.27 | 0.19 | 0.35 | 0.08 | 1.44 | 0.15 |
0.8–1 | 1.01 | 0.28 | 3.65 | 0.99 | 0.27 | 0.06 | 1.14 | 0.07 |
≥1 | 1.00 | 1.00 |
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Huang, C.H.; Lai, Y.-C.; Lee, Y.C.; Teong, X.T.; Kuzuya, M.; Kuo, K.-M. Impact of Health Literacy on Frailty among Community-Dwelling Seniors. J. Clin. Med. 2018, 7, 481. https://doi.org/10.3390/jcm7120481
Huang CH, Lai Y-C, Lee YC, Teong XT, Kuzuya M, Kuo K-M. Impact of Health Literacy on Frailty among Community-Dwelling Seniors. Journal of Clinical Medicine. 2018; 7(12):481. https://doi.org/10.3390/jcm7120481
Chicago/Turabian StyleHuang, Chi Hsien, Yu-Cheng Lai, Yi Chen Lee, Xiao Tong Teong, Masafumi Kuzuya, and Kuang-Ming Kuo. 2018. "Impact of Health Literacy on Frailty among Community-Dwelling Seniors" Journal of Clinical Medicine 7, no. 12: 481. https://doi.org/10.3390/jcm7120481
APA StyleHuang, C. H., Lai, Y. -C., Lee, Y. C., Teong, X. T., Kuzuya, M., & Kuo, K. -M. (2018). Impact of Health Literacy on Frailty among Community-Dwelling Seniors. Journal of Clinical Medicine, 7(12), 481. https://doi.org/10.3390/jcm7120481