Is the cloze procedure appropriate to evaluate health literacy in older individuals? Age effects in the test of functional health literacy in adults.

Health literacy has received increasing attention because of its importance for older individuals' health, as studies have shown a close relation between older individuals' health literacy and their health. Research also suggests that older individuals have low levels of health literacy, but this finding is variable and may depend on which health literacy test is used. Older individuals assessed with the Test of Functional Health Literacy (TOFHLA) score lower than younger individuals, but a previous study suggested that this may result from age-related differential item functioning (DIF) on the TOFHLA. The study reported here assessed age-related DIF in a sample of community-dwelling volunteers. Twenty-two percent of items were differentially more difficult for older individuals independent of their overall ability, and when these items were eliminated from the total score, age differences were no longer found. Performance on a working memory task predicted older but not younger individuals' performance on the age-related items. At least part of older individuals' apparent deficits in health literacy when assessed by the TOFHLA may be related to DIF on its items. The TOFHLA, and any measure that employs the cloze procedure to evaluate reading comprehension, should be used cautiously in older individuals.

健康素养因其对老年人健康的重要性而受到越来越多的关注，因为研究表明老年人的健康素养与其健康之间存在密切关系。研究还表明老年人的健康素养水平较低，但这一发现存在差异，可能取决于所使用的健康素养测试。使用功能性健康素养测试（TOFHLA）评估时，老年人的得分低于年轻人，但先前的一项研究表明，这可能是由于TOFHLA上与年龄相关的项目功能差异（DIF）所致。此处报道的研究对社区居住志愿者样本中的与年龄相关的DIF进行了评估。22%的项目对老年人来说难度更大，且与他们的整体能力无关，当这些项目从总分中剔除时，不再发现年龄差异。工作记忆任务的表现可以预测老年人在与年龄相关项目上的表现，但不能预测年轻人的表现。当使用TOFHLA进行评估时，老年人在健康素养方面明显的缺陷至少有一部分可能与其项目上的DIF有关。在老年人中应谨慎使用TOFHLA以及任何采用完形填空程序来评估阅读理解的测试方法。