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Association between community-level health literacy and frailty in community-dwelling older adults

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Abstract

Aims

We aimed to investigate whether high community-level health literacy, beyond individual-level health literacy, is associated with a low prevalence of frailty among community-dwelling older adults.

Methods

A large cross-sectional questionnaire survey was conducted among citizens in Maizuru City, Kyoto, Japan, aged 65 years or older who were not certified as “support” or “care” level according to Japan’s public long-term care insurance system, who could perform basic activities of daily living, and who did not have dementia or Parkinson’s disease. Frailty status was assessed using the Kihon Checklist, with a score ≥ 8 indicating frailty. Health literacy was assessed using the Communicative and Critical Health Literacy Scale. The mean health literacy score of 20 school districts was used as the community-level health literacy index. We investigated demographic data and other potential confounding factors, including education, living arrangement, body mass index, comorbidity, smoking status, depressive symptoms, social networks, and community-level covariates.

Results

The primary analysis included 6230 individuals (mean age = 74.3 years [SD = 6.1]). In each school district, the prevalence of frailty was 21.2–34.2% (mean: 26.2%), and community-level health literacy index was 3.1–3.5 (mean: 3.4). Multilevel logistic regression model including school district as random effect showed that the community-level health literacy was significantly associated with frailty (odds ratio [95% confidence interval] = 0.28 [0.08 to 0.96]) after adjusting for the covariates.

Conclusions

Not only high individual-level health literacy but also high community-level health literacy is associated with a low prevalence of frailty in community-dwelling older adults.

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Data availability

We cannot publicly provide individual data due to participants' privacy, as specified by the ethics committee. The informed consent obtained does not include a provision for publicly sharing data.

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Acknowledgements

We wish to thank the staff in the Maizuru City office for their contributions.

Funding

This research was supported by a research grant from the Japanese Physical Therapy Association for a large clinical trial.

Author information

Authors and Affiliations

  1. Graduate School of Rehabilitation Science, Osaka Metropolitan University, 3-7-30 Habikino, Habikino-City, Osaka, 583-8555, Japan

    Kazuki Uemura

  2. Section of Education for Clinical Research, Kyoto University Hospital, Kyoto, Japan

    Kamitani Tsukasa

  3. Center for Liberal Arts and Sciences, Faculty of Engineering, Toyama Prefectural University, Imizu, Japan

    Atsuya Watanabe & Hiroshi Okamoto

  4. Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan

    Minoru Yamada

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  1. Kazuki Uemura
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  2. Kamitani Tsukasa
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  3. Atsuya Watanabe
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  4. Hiroshi Okamoto
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  5. Minoru Yamada
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Contributions

KU Conceptualization, Formal analysis, Data curation, Funding acquisition, Investigation, Methodology, Project administration, Writing–original draft. TK Methodology, Supervision, Writing–review & editing. AW Data curation, Investigation, Writing–review & editing. HO Project administration, Investigation, Supervision, Writing–review & editing. MY Conceptualization, Investigation, Methodology, Project administration, Supervision, Writing–review & editing.

Corresponding author

Correspondence to Kazuki Uemura.

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All authors declare no conflict of interest.

Statement of human and animal rights

The study was compliant with the declaration of Helsinki. This study was approved by the Institutional Ethics Committee of Toyama Prefectural University (No. R1-1).

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Informed consent and participant responses to the questionnaires were obtained simultaneously from all participants.

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Uemura, K., Tsukasa, K., Watanabe, A. et al. Association between community-level health literacy and frailty in community-dwelling older adults. Aging Clin Exp Res 35, 1253–1261 (2023). https://doi.org/10.1007/s40520-023-02405-y

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