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U.S. Department of Health and Health Services
Quick Guide to Health Literacy and Older Adults
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Cognitive Challenges

Aging results in normal changes in cognition. Three specific changes are reduced processing speed, greater tendency to be distracted, and reduced capacity to process and remember new information at the same time—which is called "working memory." The nature of these changes often leads to negative stereotypes about older adults, but in fact the changes are expected and are not signs of "cognitive impairment." Nevertheless, fast presentation of materials, frequent change of focus, and a background of distractions and intrusions will reduce understanding and recall of information for older persons.1,2

Other factors that reduce cognition and health literacy include:

  • Vision and hearing problems.
  • Stress.
  • Fatigue.
  • Depression.
  • Medicine.

Aging often includes more time spent on health-related matters. Many adults manage multiple medical conditions for themselves and others. These conditions can increase a person's chances of being distracted and forgetful, meaning he or she may miss appointments, forget to take medicine, or leave the stove on by accident. In addition, the same factors that affect memory can also affect "executive function." Executive function is a term for the ability to develop, carry out, and make necessary changes to goal-related plans. Executive capabilities are essential to a person's health literacy and health self-management.1,3

An important consideration for communicating health information is to make sure specific details and time-related actions are understood. Poor comprehension of such information can result in decisions and actions based on only a general or "gist-based" understanding. For example, the specific order and time to use ice or heat on a muscle sprain is important. For swelling to be reduced, a person must know the time-related context of that information. When it is poorly presented and a person's working memory is challenged, that person often remembers and acts only on the last part of "step-by-step" information. A poor understanding of the order of actions can result in poor executive function.1

Another important consideration is to avoid mixing positive and negative information. Doing so may cause people to remember messages incorrectly, especially when the information is new. For example, you may repeatedly remind a patient, "Do not to take this pill with food." But that patient may actually remember the instruction as, "Take this pill with food." Also, frequent repetition of information as "not true" may result in that information being remembered as "true." Older adults are more likely to interpret the increasing familiarity of a message as truthfulness.1,4,5

What You Can Do

Starter Tips

Repeat essential information.

  • Repeating information several times may help people with memory problems.
  • When writing, be specific and repeat your points. Use pronouns such as "it," "this," and "that" sparingly because they are indefinite in meaning.

Focus on important details.

  • When communicating, stay focused on important details. Personalize information when possible and minimize distractions.
  • Be sure details such as timing and the order of health-related actions are understood.

Emphasize desired actions.

  • Communicate directions and advice that older adults need to follow, not actions they should avoid. This helps boost memory for appropriate action and reduces confusion. Be aware that familiarity may be interpreted as truthfulness.
  • Avoid using a "myth vs. fact" format.

Use plain language.

  • Writing and speaking in plain language boosts understanding for people with health literacy problems.
  • Organize your information with the most important points first.
  • Break information into chunks.
  • Use simple words and active voice.
  • If you need to use a difficult word, explain it.

Consider the effects of stress and fatigue.

  • Know that the stress that comes with illness and self-care can make anyone tired.
  • Understand that mistakes in judgment, errors, and depressed mood may result more from sickness than cognitive changes.
  • If managing technology or a medical device is important to a person's health, be sure that person can use the technology or device when tired and stressed.
  • Ask stressed older adults to bring family or friends with them to appointments.
  • When possible, communicate important information during times of low stress.

Be aware of the effects of illness and recovery.

  • Illness, or recovery from treatments such as chemotherapy and surgery, can temporarily reduce cognitive function. A person's ability to self-manage treatment or recovery can be compromised under these conditions.
  • Some medical conditions can result in permanent changes in executive function.

Be sensitive to individual needs.

  • Not every older adult is the same, and not every older adult will experience significant mental decline. Some just need help in specific areas, so look for ways to clarify those needs.

Provide adequate time for instruction.

  • A slower pace may be needed when working with older adults. Factor in extra time so you can adjust the pace with which you deliver instructions.

References for this table: 1,6,7,8,9

Resource is a Federal Web site that includes a large amount of information and resources on plain language. Visit the site at


  1. Information included here with the expert guidance of Elias JW, University of California, Davis.
  2. Levitt T, Fugelsang J, Crossley M. Processing speed, attentional capacity, and age-related memory change. Experimental Aging Research. 2006;32:263–295.
  3. Barrington L, Yoder-Wise PS. Executive control function: a clinically practical assessment. Journal of Gerontological Nursing. 2006;32(2):28–34.
  4. Park D. Consumer Fraud and the Aging Mind. Scientific Testimony Presented to the Senate Special Committee on Aging. July 27, 2005. Available at EXIT Disclaimer Accessed July 2007.
  5. Skurnik I, Yoon C, Park DC, Schwarz, N. How warnings about false claims become recommendations: Paradoxical effects of warnings on beliefs of older consumers. Journal of Consumer Research. 2005;31:713–724.
  6. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Quick Guide to Health Literacy. Available at Accessed July 2007.
  7. Stableford S, Mettger W. Plain Language: A Strategic Response to the Health Literacy Challenge. Journal of Public Health Policy. 2007;28:71–93.
  8. Royall DR. Précis of executive dyscontrol as a cause of problem behavior in dementia. Experimental Aging Research. 1994;20,73–94.
  9. Elias JW, Treland JT. Executive function in Parkinson's disease and subcortical disorders. Seminars in Clinical Neuropsychiatry. 1999;4(1):34–40.
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