Aging Clinical and Experimental Research

, Volume 31, Issue 12, pp 1827–1832 | Cite as

The association of health literacy, numeracy and graph literacy with frailty

  • Aakashi Shah
  • Juliana Ferri-Guerra
  • Mohammed Y. Nadeem
  • Douglas Salguero
  • Raquel Aparicio-Ugarriza
  • Marianne Desir
  • Jorge G. RuizEmail author
Original Article



Frailty is a state of vulnerability to stressors which may result in high mortality, morbidity, and health-care utilization in older adults. Whether health literacy, graph literacy and numeracy are associated with frailty is unknown.


To assess the association of health literacy, numeracy and graph literacy with frailty in male veterans.


This is a retrospective study of 470 cognitively intact, non-depressed veterans who completed evaluations of health literacy, numeracy and graph literacy at Miami VA facility in 2012. A 43-item frailty index was created as a proportion of all potential variables (demographics, comorbidities, number of medications, laboratory tests, and activities of daily life). Odds ratios and 95% confidence intervals were calculated by multinomial logistic regression models with frailty status (robust, prefrail and frail) as the outcome variable, and with health literacy, numeracy, and graph literacy scores as independent variables. Age, race, ethnicity, education, socio-economic status, and comorbidities were considered as covariates.


Patients were 100% male, 40% White, 82% non-Hispanic, mean age was 56.8 years. The proportion of robust, pre-frail and frail was 10.0%, 61.3% and 28.7%, respectively. Neither health literacy nor objective nor subjective numeracy was associated with frailty after adjustment for covariates. In contrast, higher graph literacy scores were associated with a lower risk for frailty (p = .015) even after adjusting known risk factors for frailty.

Discussion and conclusion

Neither health literacy nor numeracy is associated with frailty. Higher graph literacy score is associated with a lower risk for frailty even after adjusting for known risk factors for frailty.


Frailty Health literacy Numeracy Graph literacy Veterans 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

We obtained approval from our IRB as a quality improvement project exempted from informed consent to conduct a retrospective electronic health record review.

Supplementary material

40520_2019_1182_MOESM1_ESM.docx (18 kb)
Supplementary material 1 (DOCX 18 kb)


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Copyright information

©  This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply  2019

Authors and Affiliations

  1. 1.Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Veterans Successful Aging for Frail Elders (VSAFE)MiamiUSA
  2. 2.University of Miami Miller School of MedicineMiamiUSA

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