Rush Alzheimer's Disease Center, Rush University Medical Center.
Psychol Aging. 2013 Sep;28(3):614-24. doi: 10.1037/a0033103. Epub 2013 Aug 19.
Literacy is an important determinant of health and well-being across the life span but is critical in aging, when many influential health and financial decisions are made. Prior studies suggest that older persons exhibit lower literacy than younger persons, particularly in the domains of financial and health literacy, but the reasons why remain unknown. The objectives of this study were to: (a) examine pathways linking diverse resources (i.e., education, word knowledge, cognitive function, and decision making style) to health and financial literacy among older persons and determine the extent to which the relation of age with literacy represents a direct effect versus an indirect effect due to decrements in specific cognitive functions (i.e., executive functions and episodic memory); and (b) test the hypothesis that declines in executive function and episodic memory are associated with lower literacy among older persons without dementia. Six-hundred and forty-five community-based older persons without dementia underwent detailed assessments of diverse resources, including education, word knowledge, cognitive function (i.e., executive function, episodic memory) and decision making style (i.e., risk aversion), and completed a measure of literacy that included items similar to those used in the Health and Retirement Study, such as numeracy, financial concepts such as compound inflation and knowledge of stocks and bonds, and important health concepts such as understanding of drug risk and Medicare Part D. Path analysis revealed a strong effect of age on literacy, with about half of the effect of age on literacy due to decrements in executive functions and episodic memory. In addition, executive function had an indirect effect on literacy via decision making style (i.e., risk aversion), and education and word knowledge had independent effects on literacy. Finally, among (n = 447) persons with repeated cognitive assessments available for up to 14 years, regression analysis supported the association of multiple resources with literacy; moreover, more rapid declines in executive function and episodic memory over an average of 6.4 years prior to the literacy assessment predicted lower literacy scores (ps < 0.02), but rate of decline in word knowledge did not. These findings suggest that diverse individual resources contribute to financial and health literacy and lower literacy in old age is partially due to declines in executive function and episodic memory.
识字能力是一个人在整个生命周期中健康和幸福的重要决定因素，但在老龄化时期尤为关键，因为许多有影响力的健康和财务决策都是在这个时期做出的。先前的研究表明，老年人的识字能力低于年轻人，尤其是在金融和健康识字方面，但原因尚不清楚。本研究的目的是：(a) 探讨将不同资源（即教育、词汇知识、认知功能和决策风格）与老年人的健康和金融识字能力联系起来的途径，并确定年龄与识字能力的关系是直接影响还是由于特定认知功能（即执行功能和情景记忆）的下降而产生的间接影响；(b) 检验假设，即执行功能和情景记忆的下降与无痴呆症的老年人较低的识字能力有关。645 名无痴呆症的社区老年人接受了不同资源的详细评估，包括教育、词汇知识、认知功能（即执行功能、情景记忆）和决策风格（即风险规避），并完成了一项识字能力测试，其中包括与健康和退休研究中使用的相似的项目，如计算能力、金融概念（如复合通胀和股票和债券知识）以及重要的健康概念（如理解药物风险和医疗保险部分 D）。路径分析显示，年龄对识字能力有很强的影响，年龄对识字能力的影响约有一半是由于执行功能和情景记忆的下降所致。此外，执行功能通过决策风格（即风险规避）对识字能力产生间接影响，而教育和词汇知识对识字能力有独立的影响。最后，在（n = 447）可获得长达 14 年重复认知评估的人群中，回归分析支持了多种资源与识字能力的关联；此外，在识字能力评估前平均 6.4 年，执行功能和情景记忆的下降速度越快，识字能力得分越低（p < 0.02），但词汇知识的下降速度则没有。这些发现表明，不同的个体资源有助于金融和健康识字能力，而老年人的识字能力较低部分是由于执行功能和情景记忆的下降所致。
