Allison R. Kaup, PhD, is a researcher studying cognition in aging. She is currently a postdoctoral fellow with the Sierra Pacific Mental Illness Research, Education and Clinical Centers (MIRECC) at the San Francisco VA Medical Center and University of California San Francisco, where she is mentored by Dr. Kristine Yaffe. Her research focuses on investigating risk factors for and protective factors against age-related cognitive decline and dementia to identify potential ways to promote good cognitive functioning even among older adults that are at high risk for dementia.

ElderBranch spoke with Dr. Kaup about her paper, “Older Adults With Limited Literacy Are at Increased Risk for Likely Dementia,” which she wrote along with Eleanor M. Simonsick and Tamara B. Harris of the National Institute on Aging, Suzanne Satterfield of the University of Tennessee Health Science Center, Andrea L. Metti of the University of Pittsburgh’s Graduate School of Public Health, and Hilsa N. Ayonayon, Susan M. Rubin, and Kristine Yaffe of the University of California San Francisco.

What led you to examine the relationship between limited literacy and an increased risk for likely dementia? Why is this important?

As we all know, dementia is a devastating condition for patients and their loved ones. Our research focuses on studying factors that help predict who might experience cognitive decline and develop dementia in older age, with the ultimate goal of trying to identify ways to help prevent dementia.

There is a large body of evidence suggesting that individuals who complete more years of education are less likely to develop dementia. In this way, higher education is thought to help protect against dementia.

It is also thought that literacy level might be a better indicator of the quality of education individuals received, as opposed to just measuring the number of years of school they finished. It is also apparent from national studies (i.e., the 2003 National Assessment of Adult Literacy) that older adults are more likely to have lower literacy than other age groups. For these reasons, we wanted to study the relationship between literacy and the development of dementia.

Please describe your study. What were your in-going hypotheses? What method did you use to test them?

We hypothesized that older adults with limited literacy (defined as reading at less than a 9th grade level) would be more likely to develop dementia, compared to individuals with higher literacy (at or above a 9th grade level).

Our study utilized data from the Health, Aging, and Body Composition study, which is a large study of community-dwelling older adults who have been repeatedly evaluated over several years.

We studied more than 2,400 older adults (ages 71 to 82) who completed a literacy assessment, for which they read words of varying difficulty aloud. We then measured who among these individuals appeared to develop “likely dementia” over the following eight years, which we defined based on their hospital records, whether they were prescribed medication for dementia, or whether they showed significant decline on a cognitive measure.

We then used statistical models to investigate whether literacy level was associated with who developed likely dementia. We also examined whether other individual characteristics like demographics, years of education, income, health problems, or having a particular genotype affected this relationship.

What were your key findings?

We found that older adults with limited literacy were more likely to show signs of having dementia over the eight-year period than were older adults with higher literacy.

Further, we found that literacy was an important predictor; limited literacy helped predict who developed likely dementia even when we also accounted for other factors like years of education and health problems.

Would you make any specific public health policy recommendations as a result of your findings?

Previous research has shown that having lower literacy is relatively common among older adults. Our study provides further evidence that this is an important public health problem since our findings suggest that limited literacy is a risk factor for dementia.

We believe that future studies should investigate whether interventions can be developed to improve literacy in older adults and also whether such improvements could help to prevent individuals from developing dementia.

What are the next steps to further your work in this area?

As a next step, I plan to investigate whether factors like having better literacy, obtaining higher education, and/or engaging in more cognitively-stimulating activities throughout one’s life could help to prevent dementia even among certain older adults who are most at-risk for dementia based on other factors.

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