Many paid caregivers lack health literacy skills

More than a third of the people paid to care for seniors are not health literate, and 60% wrongly interpret the instructions on prescription labels, a study says.

Caregivers often are hired by families to help care for seniors with cognitive loss, dementia or Alzheimer's disease and who have trouble performing daily activities such as toileting, bathing, cooking and shopping. This makes it especially important that caregivers have the ability to understand health-related instructions, said Lee A. Lindquist, MD, MPH, lead author of the study published in May's Journal of General Internal Medicine (link).

Caregivers' poor health literacy skills can affect patient care, said Dr. Lindquist, a geriatrician at Northwestern Memorial Hospital in Chicago.

"Many times, I see patients cared for by caregivers. They come with the senior to the doctor's visit," she said. "You can't really tell the senior information because they have cognitive issues that don't allow them to process it. And the caregiver doesn't quite get the concept sometimes. They nod their heads saying they do understand, but the patients come back a couple of weeks later with the same high blood pressures and the same issues because the medication directions haven't been followed."

For the study, researchers gave health literacy tests to 98 paid caregivers of seniors in the Chicago area. For example, caregivers were given written information about an upcoming clinic appointment and were asked questions about the time and location of the appointment.

Another test involved reading prescription labels and properly filling pill boxes based on instructions. Nearly two-thirds of the caregivers with poor health literacy skills correctly dispensed a three-times daily medication, but that correct-response rate dropped when the instructions were more complicated, the study said.

Notably, the health literacy of the caregivers studied was superior to that of the U.S. population at large. Forty-six percent of Americans are not health literate, according to a February 2005 Journal of General Internal Medicine study (link).

Sparse caregiver training

Few regulations cover caregivers or the agencies through which they are employed, and the quality of training provided varies widely, Dr. Lindquist said. The average hourly pay of the caregivers who participated in the study was $8.91. Nearly 40% were American, 34% came from the Philippines, 19% were Mexicans and the remainder came from Africa, Eastern Europe and India.

"Physicians need to be cognizant that with patients who are considered nonadherent or who have a hard time controlling blood pressures or other chronic issues, instead of looking at the patient, they may need to look at who's giving the medications or the caregivers," Dr. Lindquist said.

Doctors should use simple, jargon-free language and ask caregivers to repeat back in their own words what they understand the instructions to be, she added. If there is a problem, physicians should alert the senior's family so someone else can come to physician visits and supervise medication dispensing.

"We're not saying that these caregivers who have low health literacy are bad," Dr. Lindquist said. "Many are super-motivated and are trying their hardest. They are just concerned that if they say they don't know how to do [health-related tasks] that they might lose their jobs or be sent back home."