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Northwestern University Feinberg School of Medicine
Center for Applied Health Research on Aging
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Health Literacy and Cognitive Function Among Older Adults


September 2007- February 2020

Funding Source:

National Institute of Aging (NIA)

Grant Number:



The number of adults over 65 is expected to double by 2050. Health systems must urgently seek ways to support the many older adults contending with increasingly complex chronic disease self-management, in the face of declining cognitive resources that also is the result of aging. This study aims to elucidate potentially modifiable, causal mechanisms linking cognitive decline to worse health that will aid in the design of effective, health system-led, health literacy & self-management interventions.


LitCog is a longitudinal cohort study, now in its twelfth year of funding. We are investigating associations between cognitive function and health literacy and how these factors affect performance on a range of common, health self-management tasks. Initially a cross-sectional study (LitCog I), 900 adults ages 55-74 were recruited in 2008 from 8 community-based, primary care practices in Chicago. Participants completed a series of comprehensive cognitive, psychological, social, behavioral, and health assessments (`T1' interview). We have now established a cohort with our first renewal (LitCog II), completing follow-up assessments every 3 years (T2, & T3; 78.2% retention rate). The objective of LitCog II has been to examine changes in cognitive function, health literacy, and self-management skills over 6 years, and their associations with patient-reported physical and mental health status. We have found: (1) cognitive function is strongly associated with health literacy - both factors decline over time (T1 to T3); (2) cognitive function and health literacy are associated with self-management skills and all are related to physical/mental health; (3) less-studied factors (e.g. patient activation, personality, technology use) may mediate/moderate associations. A final T4 assessment 10 years post-baseline is now proposed (LitCog III). This is an unprecedented opportunity to not only definitively learn whether cognitive function determines older adults' health literacy and self-management skills, but how these factors decline and impact health services use and outcomes over time. LitCog III is warranted for many reasons. First, with electronic access to medical/pharmacy records now at all sites (T1 to 1 year post T4), we can examine outcomes previously not possible due to limited resources, data availability, or insufficient follow-up time. Second, while decline in both cognitive function and health literacy is evident, the extent of decline is just emerging. Third, all participants hav a chronic illness, 77% have 2+, 60% have new diagnoses post-T1; effects of increasing disease/treatment burden on cognition, health literacy, and self-management skills has not been studied. Finally, 10 years of extended follow-up allows us to examine bi-directional associations between changes in cognitive function, health literacy, presence and clinical status of chronic disease. Our specific aims are to: Aim 1 Determine whether decline in cognitive function, health literacy and self-management skills over 10 years predict poorer health outcomes among older adults. Aim 2 Assess whether decline in cognitive function, health literacy and self-management skills leads to excess healthcare resource use among older adults. Aim 3 Identify less-studied factors that influence longitudinal associations between cognitive function, health literacy, self-management skills, and outcomes reported from Aims 1 and 2. identifier:



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

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