Decision Making and Health Literacy among Older Adults

Older adults make many decisions about their health, in part because they are the most frequent patients in a health-care system that places a premium on patient engagement and decision making. They face complex health-related decisions that involve receiving care from multiple providers for interacting chronic and acute conditions. Older adults with lower levels of education and health literacy especially struggle, because they are more likely to have chronic illness and receive complex care, yet have fewer resources for making decisions. In this chapter we consider decision making from the perspective of health literacy and cognitive aging. Decision making is analyzed in terms of finding, understanding, and acting on linguistic and numeric health information. We consider how these processes are influenced by the interaction of age-related changes in patient resources, including declines (e.g., processing capacity), gains associated with experience (general and health-specific knowledge), and changing life goals (e.g., increasing importance of affect and emotion).