In this study we focus on functional health literacy being able

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pandora bracelets Dr. Nina Bascia, Ontario Institute for Studies in Education, led an extensive study on the effects of putting in class sizes. Her report found that while students were more engaged in smaller classes, is not a magic bullet. The limited health literacy capabilities within this population have implications for the design and delivery of health related services for older adults in England.IntroductionHealth literacy has been defined as “the degree to which individuals have the capacity to obtain pandora charms, process and understand basic health information and services needed to make basic health decisions.”1 2 The World Health Organization and organisations responsible for public health in the United States and Canada have identified health literacy as an important determinant of population health.3 4 5 A rapidly growing body of research is exploring the gap between patients’ health literacy and the capabilities needed to effectively manage health.2 6 For example, lower health literacy is associated with less knowledge of chronic disease processes,7 poorer mental and physical health, limited use of preventive services, and higher rates of hospital admissions.8 Evidence for these associations emanates largely from the United States.9 In the United Kingdom, patients are increasingly expected to become active partners in their care, yet neither “health literacy” nor “literacy” is explicitly mentioned by the government in recent health strategies.10 11 Is health literacy an important determinant of health outcomes in the context of universal healthcare provision? We investigated the association between health literacy and mortality among older adults in England.In this study we focus on functional health literacy being able to apply reading skills and basic knowledge in a health context.12 Health literacy, based on widely used measures of health related word recognition and comprehension, correlates strongly with general literacy13 14 but is assessed with greater health specific content.15 Health literacy is also associated with cognitive abilities, including processing speed and working memory.16 17 Low health literacy is predicted by older age, lower income, fewer education qualifications, and being from an ethnic minority group, yet the relation between health literacy and health is reported to persist after accounting for education and other socioeconomic indicators.2 7 8 Although educational attainment is typically stable after early adulthood, an individual’s health literacy may increase (for example, through interaction with peers or medical professionals), or decrease as part of a general decline in cognitive capabilities with age.18 Intervention studies to tackle low health literacy have led to improvements in self care and quality of life, lending importance to health literacy as a potentially modifiable risk factor.19Low health literacy may lead to particularly harmful consequences in older age, given the complexities of managing chronic disease and age related cognitive decline.20 21 We investigated whether low health literacy was associated with an increased risk of mortality in older adults in England, independent of established risk factors, including age, socioeconomic position, and pre existing illness. We hypothesised that harmful lifestyle behaviours and weaker cognitive function would contribute to a significant association between low health literacy and increased mortality.MethodsThe sample was drawn from the second wave (2004 5) of the English Longitudinal Study of Ageing, a national cohort study established in 2002 to study health and ageing in adults aged 50 years and above.22 Participants are contacted every two years for interview and every four years for a health examination. The initial interview (wave 1) included a nationally representative sample of 12099 adults aged 50 or more from private households who had participated in the health survey for England in 1998, 1999, and 2001 an annual government health survey based on a stratified random sample of all households in England pandora bracelets.

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