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LitCog Caregiver


Supplement to LitCog III: Health Literacy and Cognitive Function Among Older Adults


September 2018- February 2025

Funding Source:

National Institute of Aging (NIA)

Grant Number:



Alzheimer’s disease and related dementias (ADRD) continue to devastate individuals and their families. The current response by health systems has been variable and often ineffective at maintaining functional health status and optimizing quality of life among persons with ADRD. We will expand an ongoing NIA cohort study investigating cognitive decline and its impact on health to include the experiences of involved caregivers, to more readily identify modifiable factors that could be targeted by health system interventions aimed at supporting families affected by ADRD.


We expand our ongoing NIA cohort study, known as ‘LitCog’, investigating cognitive decline and its impact on chronic disease self-management and functional health status among older adults to include investigations into the presence, roles, and influence of informal caregivers. Since enrollment in LitCog, one third of participants have developed mild cognitive impairment (MCI) or dementia, broadly classified within the definition of Alzheimer’s disease and its related dementias (ADRD).

LitCog includes examinations of the impact of cognitive impairment (including onset of ADRD) on a patient’s health literacy (HL) skills that determine proper chronic disease self-management, which is strongly linked to functional health status and chronic disease outcomes. We do not, however, account for the involvement of a family member or friend as an ‘informal caregiver’. Half of LitCog participants live alone; 1 in 5 are considered socially isolated, and 25% self-report needing assistance in managing their health. Caregivers could be of great benefit, but their ability to effectively support older patients with ADRD may depend on their own HL skills, functional health status, and other psychosocial factors. The availability, but also adequacy of support provided by caregivers may critically determine the health of persons with dementia, yet research on explicit caregiver competencies remains limited. Understanding these associations could inform health system responses.

Our primary aims and hypotheses (H) are to:

Aim 1 Investigate the HL skills of informal caregivers to older adults with and without ADRD, and examine associations between caregiver HL and patient functional health status.
Aim 2 Evaluate associations between the presence of an informal caregiver with treatment adherence, chronic disease outcomes, and functional health status of older adults with ADRD.
Aim 3 Identify factors influencing associations between caregiver HL and patient health outcomes.
Aim 4 Determine whether the involvement of an informal caregiver with adequate HL can reduce excess healthcare use among older adults with ADRD. identifier:



• Principal Investigator: Michael S. Wolf, PhD MPH
• Project Lead: Morgan Bonham