Limited health literacy is a barrier to colorectal cancer screening in England: Evidence from the English Longitudinal Study of Ageing.

To determine the association between health literacy and participation in publicly available colorectal cancer (CRC) screening in England using data from the English Longitudinal Study of Ageing (ELSA)

Perceived life expectancy and colorectal cancer screening intentions and behaviour: A population-based UK study

The relationships between perceived life expectancy (PLE), cancer screening intentions and behaviour are not well understood, despite the importance of remaining life expectancy for the early diagnosis benefits of screening. This study investigates the relationships between PLE and each of: the intention to complete faecal occult blood test (FOBt) screening, 'ever' uptake of FOBt screening, and repeat uptake of FOBt screening for colorectal cancer. Data were from the population-representative Attitudes, Behaviour and Cancer UK Survey II (ABACUS II) in England in 2015. Eligible respondents for the present analysis were aged 60-70 years (FOBt eligible age range), who completed the survey question on perceived life expectancy (N = 824). We used logistic regression models to estimate the associations between PLE and the intention to complete screening, 'ever' uptake of screening, and repeat uptake of screening, with adjustment for age, gender, occupation-based social grade, marital status, ethnicity, and smoking status. PLE was positively associated with repeated uptake of FOBt (adjusted OR = 2.55; 95% CI: 1.04-6.30 for expecting to live to ≥90 years versus <80 years). Older adults may base decisions to continually participate in cancer screening on their expectations of remaining life expectancy. Future research should investigate the feasibility and acceptability of individualised cancer screening recommendations that take life expectancy into account

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

Adverse Childhood Experiences and Rate of Memory Decline From Mid to Later-Life: Evidence From the English Longitudinal Study of Ageing

Evidence on the role of early-life adversity in later-life memory decline is conflicting. We investigated the relationships between adverse childhood experiences (ACEs) and memory performance and rate of decline over a ten-year follow-up among mid-to-older adults in England. Data were from biennial interviews with 5,223 participants aged 54+ in the population-representative English Longitudinal Study of Ageing from 2006/07-2016/17. We examined self-reports of nine ACEs prior to age 16, which related to abuse, household dysfunction, and separation from family. Memory was assessed at each time point as immediate and delayed recall of 10 words. Using linear mixed-effects models with person-specific random intercepts and slopes and adjusted for baseline age, age2, sex, ethnicity, and childhood socioeconomic factors, we observed that most individual and cumulative ACE exposures had null-to-weakly negative associations with memory function and rate of decline over the 10-year follow-up. Having lived in residential or foster care was associated with lower baseline memory (adjusted β = -0.124 standard deviation units, 95% confidence interval: -0.273, -0.025), but not memory decline. Our findings suggest potential long-run impacts of residential or foster care on memory, and highlight the need for accurate and detailed exposure measures when studying ACEs in relation to later-life cognitive outcomes

Social Isolation, Loneliness, and Health Behaviors at Older Ages: Longitudinal Cohort Study

Background: The prospective associations between social isolation, loneliness, and health behaviors are uncertain, despite the potential importance of these relationships over time for outcomes including mortality. // Purpose: To examine the associations between baseline social isolation, baseline loneliness, and engagement in health behaviors over 10 years among older adults. // Methods: Data were from 3,392 men and women aged ≥52 years in the English Longitudinal Study of Ageing from 2004/2005 to 2014/2015. Modified Poisson regression was specified to estimate relative risks (RRs) and 95% confidence intervals for the associations between baseline social isolation, baseline loneliness, and consistent weekly moderate-to-vigorous physical activity, consistent five daily fruit and vegetable servings, daily alcohol drinking at any time point, smoking at any time point, and a consistently overweight/obese body mass index over the follow-up (all yes vs. no). Models were population weighted and adjusted for sociodemographic factors, health indicators, and depressive symptoms, with mutual adjustment for social isolation and loneliness. // Results: Socially isolated participants were less likely than non-isolated participants to consistently report weekly moderate-to-vigorous physical activity (RR = 0.86; 0.77–0.97) or five daily fruit and vegetable servings (RR = 0.81; 0.63–1.04). They were less likely to be consistently overweight or obese (RR = 0.86; 0.77–0.97) and more likely to smoke at any time point (RR = 1.46; 1.17–1.82). Loneliness was not associated with health behaviors or body mass index in adjusted models. Among smokers, loneliness was negatively associated with successful smoking cessation over the follow-up (RR = 0.31; 0.11–0.90). // Conclusions: Social isolation was associated with a range of health-related behaviors, and loneliness was associated with smoking cessation over a 10 year follow-up in older English adults

Social contact, social support, and cognitive health in a population-based study of middle-aged and older men and women in rural South Africa

BACKGROUND: Several theories seek to explain how social connections and cognitive function are interconnected in older age. These include that social interaction protects against cognitive decline, that cognitive decline leads to shedding of social connections and that cognitive decline leads to increased instrumental support. We investigated how patterns of social contact, social support and cognitive health in rural South Africa fit with these three theories. METHOD: We used data from the baseline of "Health and Aging in Africa: a Longitudinal Study of an INDEPTH community in South Africa" (HAALSI), a population-based study of 5059 individuals aged ≥ 40 years. We evaluated how a range of egocentric social connectedness measures varied by respondents' cognitive function. RESULTS: We found that respondents with lower cognitive function had smaller, denser social networks that were more local and more kin-based than their peers. Lower cognitive function was associated with receipt of less social support generally, but this difference was stronger for emotional and informational support than for financial and physical support. Impairment was associated with greater differences among those aged 40-59 and those with any (versus no) educational attainment. CONCLUSIONS: The patterns we found suggest that cognitively impaired older adults in this setting rely on their core social networks for support, and that theories relating to social connectedness and cognitive function developed in higher-income and higher-education settings may also apply in lower-resource settings elsewhere

Decomposing socio-economic inequality in colorectal cancer screening uptake in England

Colorectal cancer (CRC) is the second largest cause of cancer death in the UK. Since 2010, CRC screening based on Faecal Occult Blood testing has been offered by the NHS in England biennially to all persons age 60-69 years. Several studies have demonstrated a gradient in uptake using area-level markers of socio-economic status (SES), but few have examined the individual-level contributors to the gradient. We aimed to quantify the extent of SES inequality in CRC screening uptake in England using individual-level data, and to identify individual factors associated with this inequality. We used data from 1833 participants (aged 61-69) in Wave 5 (collected in years 2010/11) of the English Longitudinal Study of Ageing (ELSA) eligible for having been sent at least one CRC screening invitation. Uptake was defined by self-report of ever having been screened as part of the National Screening Programme. We assessed socio-economic inequality using the corrected concentration index of uptake against SES rank, which was derived by regressing a range of SES markers against net non-pension household wealth. Other demographic and health-related variables were included in the analysis. Factors associated with inequality were measured using concentration index decomposition. There was a significant pro-rich gradient in screening uptake (concentration index: 0.16, 95% CI:0.11-0.22), mostly explained within our model by differences in non-pension wealth (38.7%), partner screening status (15.9%), sickness/disability (13.5%), and health literacy (8.5%). Interventions aimed at reducing inequalities in CRC screening uptake should focus on improving acceptability of screening in populations with low levels of education and literacy barriers

Subjective social position and cognitive function in a longitudinal cohort of older, rural South African adults, 2014–2019

BACKGROUND: The relationship between subjective social position (SSP) and cognitive ageing unclear, especially in low-income settings. We aimed to investigate the relationship between SSP and cognitive function over time among older adults in rural South Africa. METHODS: Data were from 3771 adults aged ≥40 in the population-representative 'Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa' from 2014/2015 (baseline) to 2018/2019 (follow-up). SSP was assessed at baseline with the 10-rung MacArthur Network social position ladder. Outcomes were composite orientation and episodic memory scores at baseline and follow-up (range: 0-24). Mortality- and attrition-weighted linear regression estimated the associations between baseline SSP with cognitive scores at each of the baseline and follow-up. Models were adjusted for age, age2, sex, country of birth, father's occupation, education, employment, household assets, literacy, marital status and health-related covariates. RESULTS: SSP responses ranged from 0 (bottom ladder rung/lowest social position) to 10 (top ladder rung/highest social position), with a mean of 6.6 (SD: 2.3). SSP was positively associated with baseline cognitive score (adjusted β=0.198 points per ladder rung increase; 95% CI 0.145 to 0.253) and follow-up cognitive score (adjusted β=0.078 points per ladder rung increase; 95% CI 0.021 to 0.136). CONCLUSION: Independent of objective socioeconomic position measures, SSP is associated with orientation and episodic memory scores over two time points approximately 3 years apart among older rural South Africans. Future research is needed to establish the causality of the observed relationships, whether they persist over longer follow-up periods and their consistency in other populations

Internet use, social engagement, and health literacy decline during ageing in a longitudinal cohort of older English adults

Background: Health literacy skills tend to decline during ageing, which is often attributed to age-related cognitive decline. Whether health literacy skills may be influenced by technological and social factors during ageing is unknown. Methods: We investigated whether internet use and social engagement protect against health literacy decline during ageing, independent of cognitive decline. We used prospective data from 4368 men and women aged ≥52 years in the English Longitudinal Study of Ageing from 2004-11. Health literacy was measured at baseline (2004-5) and follow-up (2010-11) using a reading comprehension test of a fictitious medicine label. The influences of consistent internet use and engagement in each of civic, leisure, and cultural activities on health literacy decline over the follow-up were estimated. Results: After adjusting for cognitive decline and other covariates, consistent internet use (1379/4368; 32%) was protectively associated with health literacy decline (OR=0.77; 95% CI: 0.60-0.99), as was consistent engagement in cultural activities (1715/4368; 39%; OR=0.73; 95% CI: 0.56-0.93) As the number of activities engaged in increased, the likelihood of health literacy decline steadily decreased (ptrend<0.0001), with OR=0.51 (95% CI: 0.33-0.79) for engaging in all four of internet use and civic, leisure, and cultural activities vs. none. Conclusion: Internet use and social engagement, particularly in cultural activities (e.g. attending the cinema, art galleries, museums, and the theatre) may help older adults to maintain health literacy during ageing. Support for older adults to maintain socially engaged lives and to access the internet should help promote the maintenance of functional literacy skills during ageing

Aging and functional health literacy: a systematic review and meta-analysis

OBJECTIVES: To review the evidence on the association between age and limited health literacy, overall and by health literacy test, and to investigate the mediating role of cognitive function. METHODS: The Embase, MEDLINE®, and PsycINFO databases were searched. Eligible studies were conducted in any country or language, included participants aged ≥50 years, presented a measure of association between age and health literacy, and were published through September 2013. RESULTS: Seventy analyses in 60 studies were included in the systematic review; 29 of these were included in the meta-analysis. Older age was strongly associated with limited health literacy in analyses that measured health literacy as reading comprehension, reasoning, and numeracy skills (random effects OR=4.20; 95% CI: 3.13-5.64). By contrast, older age was weakly associated with limited health literacy in studies that measured health literacy as medical vocabulary (random effects OR=1.19; 95% CI: 1.03-1.37). Evidence on the mediating role of cognitive function was limited. DISCUSSION: Health literacy tests that utilize a range of fluid cognitive abilities and mirror everyday health tasks frequently observe skill limitations among older adults. Vocabulary-based health literacy skills appear more stable with age. Researchers should select measurement tests wisely when assessing health literacy of older adults