Health literacy during ageing and implications for health behaviour

Ageing involves rising challenges for health and well-being. At the same time, older age has been associated with having low health literacy. Health literacy is essential for comprehension of the complex information that older adults need to make health decisions. Health literacy and its health behavioural outcomes during ageing have never been examined longitudinally. This thesis reviews the literature and uses data from the English Longitudinal Study of Ageing to address these gaps. Study 1, a systematic review and meta-analysis, shows that health literacy skills based on active learning may decline with age, while vocabulary-based skills are stable with age. Study 2 shows that health literacy declines in about one-fifth of English adults aged over 50 years, and that cognitive function and decline mostly explain ageing-related health literacy decline. Men, ethnic minorities, and adults with no education and in low occupational classes are the most vulnerable to losing health literacy during ageing. Study 3 demonstrates that sustained Internet use and engagement in social activities may help to prevent ageing-related health literacy decline, independently of cognitive decline. Study 4 shows that low health literacy is a barrier to participation in colorectal cancer screening, an effect mostly explained by cognitive function around the time of screening. Study 5 explores the relationships between health literacy and health behaviours over eight years, finding that health literacy may help to promote sustained regular physical activity during ageing, independently of cognitive function and physical health. Results demonstrate that health literacy is sensitive to ageing, and that cognitive function and decline play a significant role in health literacy performance at older ages. Health literacy appears to be a resource that is maintained during ageing by socially advantaged adults through specific social practices, and they use it to improve and protect their health. Limitations and future research directions are discussed