Medication Literacy: A Helpful Concept for Understanding Medication Decision Making among Older Adults

While health literacy is widely understood as a quality measure of health care decision making, another related measure calls for increased attention, particularly regarding older adults: medication literacy. Medication literacy is the degree to which individuals can obtain, comprehend, communicate, calculate, and process patient-specific information about their medications to make informed medication and health decisions in order to safely and effectively use their medications, regardless of the mode by which the content by which the content is delivered (i.e., written, oral, or visual).

Available Studies Suggest Low Medication Literacy Levels Among Older Adults

While researchers have developed several medication literacy measures, they have neither received broad validation nor enjoyed wide application. As such, understanding the broader category of health literacy may be the first step to understanding medication literacy among older Americans.

According to the National Assessment of Adult Literacy (NAAL), 36 percent of American adults have limited health literacy skills, meaning that an individual has basic or below basic skills to perform simple and everyday literacy activities, such as reading and understanding information in simple documents or locating numbers and using them to solve simple, one-step problems. Older adults have the highest rates of low health literacy among all age groups: 59 percent of adults ages 65 and older had basic or below basic health literacy levels and have significantly lower rates of both proficient (3 percent) and intermediate (38 percent) levels of health literacy.

The NAAL also showed wide racial and ethnic disparities in health literacy. Black (58 percent), Hispanic (66 percent), and Native American (48 percent) adults had higher levels of limited literacy—below basic and basic levels—as compared to White (28 percent) adults. While the NAAL did not break out literacy levels by age and race and ethnicity, a study of Medicare enrollees showed wide gaps between the health literacy of White and Black older adults. Only 36 percent of Black enrollees had adequate health literacy levels compared to 71 percent of White enrollees, while more than half (52 percent) of Black enrollees had inadequate health literacy levels, compared to 19 percent of White enrollees.

The Value of Measuring Medication Literacy

Today, 86 percent of adults ages 65 and older regularly take at least one prescription medication. Forty two percent take five or more drugs, with the average Medicare beneficiary taking 4.6 prescriptions per month. A medication literacy tool can help evaluate the specific skills used in a significant portion of all the health care decision making among older adults, taking prescription medications, and help measure the personal health and financial impacts associated with lower literacy levels, including:

Mortality: Older adults with low medication literacy, many of whom take multiple medications, may be at higher risk for poorer health outcomes. An analysis of studies that investigated the association between mortality and polypharmacy showed an escalating relationship between the number of medications taken and an individual’s mortality risk.

Out-of-pocket costs: Medication-related costs add up quickly, and low medication literacy may contribute to the accrual. A study which estimated the total cost of additional health care expenditures due to low health literacy at $73 billion found that $11.5 billion was in individual out-of-pocket costs. In 2019, Medicare enrollees filling prescriptions under Part D paid $16.1 billion out of pocket in 2019.

Health care system costs: The high utilization of prescription drugs among older adults puts them at increased risk of adverse drug events (ADEs) and, thus, emergency department visits, hospitalizations, and associated costs. One study showed three times as many emergency department visits for ADEs among adults ages 65 and older as compared to those under age 65, and 200,000 hospitalizations in 2014 among adults ages 65 and older were due to ADEs.

Using Medication Literacy as a Tool for Change

Because low levels of literacy result in economic and health costs, an obvious solution for limiting or reducing these costs is to improve literacy levels, as is being accomplished with health literacy. To advance medication literacy and develop measurement tools to better understand the medication decision making among older adults, stakeholders should consider the following suggested actions: 

• Researchers should develop validated, comprehensive medication literacy instruments in order to inform an understanding of the skills and knowledge gaps that older Americans face. They should additionally apply these instruments to diverse sets of older adults with respect to age, socioeconomic background, race and ethnicity, and physical and mental abilities.
• Providers including primary care, specialists, pharmacists, and hospital staff should evaluate their communication across modes and settings and employ evidence-based strategies to reduce miscommunication and missed information, reinforce messages, and include an older adult’s caregiver, as appropriate, in the communications.
• Insurers should strengthen coverage of and access to services that improve medication literacy, such as medication reconciliation services and testing using vetted medication literacy instruments.
• Policymakers can allocate funds and implement new policies to create an environment for improved medication literacy. Federal officials could continue to monitor and limit drug manufacturers’ direct-to-consumer advertising and work with other stakeholders to develop a national plan to improve medication literacy. 
   

This report is one in a series on the topic of medication literacy. View the series.