LitCog V: Health Literacy and Cognitive Function Among Older Adults
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We seek to renew our longstanding cohort study, known as `LitCog' (R01AG030611), and culminate investigations of cognitive function trajectories among older adults and their involved caregivers. Since 2007, the LitCog study has examined the confluence of increased medical morbidity with older age that results in more complex patient self-management (SM) roles, and cognitive decline that may adversely affect older adults' health literacy (HL) skills, chronic illness self-care, and functional independence. Initially a cross- sectional study (LitCog I), adults ages 55-74 were recruited from community-based, primary care practices throughout Chicago. Participants completed comprehensive cognitive, psychological, social, behavioral, and functional health assessments (`T1' interview). LitCog became a cohort study with 3 renewal awards (LitCog II, III, IV); follow-up assessments have been conducted every 3 years (T2-T6). Our research has shown how cognitive function determines one's HL, that both decline together over time, and declines in certain cognitive domains adversely impact SM skills, treatment adherence, functional health status, and chronic disease outcomes. Modifiable psychological, behavioral, and social risk factors for cognitive decline have been identified. Initiated by an administrative supplement and expanded in this funding cycle (LitCog IV), a `LitCog Caregiver' cohort is now established; 3 caregiver interviews (aligned to T4-T6) have examined the presence, skills, and evolving support provided by caregivers, and whether / how their involvement has benefited LitCog participants. We now seek a LitCog V renewal that will add a T7, T8 assessment and 2 additional caregiver interviews. After 15 years, patient and caregiver participants remain available for further study. With 8 patient assessments over 2 decades, we are well-poised to assess the prevalence of and adjustment to increasing morbidity, disability, cognitive impairment (CI), and dementia. Trajectories of cognitive function, HL, SM skills, health behaviors, physical/mental health, clinical outcomes, healthcare use and mortality can be better modeled. With 5 parallel caregiver interviews over 12 years, caregiver determinants of patient health outcomes can be more precisely investigated. Costs of cognitive decline, CI and dementia will also be explored, responding to NIA priorities. Our specific aims are to: 1) finalize investigations of trajectories of cognitive function, HL, and SM skills, and their determinants, over a 20-year span among older adults; 2) determine the prevalence of CI and dementia and identify factors associated with its detection, diagnosis, and ongoing management; 3) investigate health management support roles among caregivers over 12 years; 4) estimate the direct and indirect costs of cognitive decline, cognitive impairment, and dementia from a local patient, caregiver, and health system perspective. LitCog V will be a capstone to our investigations into age-related cognitive changes with increasing comorbidity, and modifiable factors that may offset the impact of cognitive decline on health outcomes.
