Are silver surfers more health savvy?

"Older people who use the internet … may be better equipped to keep on top of their health," BBC News reports. A survey found regular internet use in older people was associated with good health literacy.

Health literacy is a term used to describe an individual's ability to find, understand and make use of health information.

The study, which involved 4,400 adults aged 52 and over, found those who regularly used the internet were less likely to experience a drop in health literacy as they got older.

Health literacy was assessed in terms of being able to understand a mocked-up medicine label at the start of the study compared with seven years later.

There was no positive link between health literacy and reading newspapers. Indeed, certain newspapers are probably the last place you want to turn to for accurate health information. There was also a positive link for people who engage in cultural activities.

The study did not assess whether the participants were healthier, and we do not know whether being able to read a medicine label gives a reliable indication of health literacy.

Still, learning to use the internet can help combat feelings of isolation. There may be an older relative or friend you know who could benefit from "silver surfing". Organisations such as Age UK offer free internet training for older people.

Where did the story come from?

The study was carried out by researchers from University College London. Funding was not reported.

It was published in the peer-reviewed Journal of Epidemiology and Community Health.

The UK media reported the findings of the study accurately, but have not discussed any of its limitations.

What kind of research was this?

This was a cohort study that aimed to assess whether regularly reading newspapers, using the internet, and being active socially could protect against age-related reduced health literacy skills.

Only a brief study abstract of the study's findings is currently available. This means it is not possible to analyse the full methods used. A more detailed report of the study, its methodology and its findings may be published later in the year or next year.

According to the World Health Organization (WHO), "health literacy" refers to the "Cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health.

"Health literacy means more than being able to read pamphlets and successfully make appointments. By improving people's access to health information and their capacity to use it effectively, health literacy is critical to empowerment."

In this study, one measure of health literacy was assessed: being able to read a mocked-up medicine label.

This type of research cannot prove that any of these factors improve or maintain health literacy, but it can show an association or link. 

What did the research involve?

Adults aged 52 or over were recruited to the study from a large ongoing study called the English Longitudinal Study of Ageing (ELSA). They were assessed at baseline in 2004-05 and followed up over the next seven years.

In this piece of research, health literacy was measured using a reading comprehension test of a fake medicine label. The 4,429 participants completed this test at the beginning of the study and again in 2010-11.

Every two years, data was also collected through interviews and questionnaires on whether the participants:

• read the newspaper daily versus never
• used the internet consistently or never
• engaged in civic participation or not
• performed leisure activities or not
• engaged in cultural activities or not
• engaged in social networks or were socially detached

The researchers then performed statistical analyses to look for links between reading, the internet, social engagement and maintained health literacy from the beginning to the end of the study period.

They adjusted the results to take the following confounders into account:

• baseline age
• ethnicity
• education
• cognitive function
• cognitive decline

What were the basic results?

People who used the internet "consistently" compared with "never" were 25% less likely to have a decline in health literacy (odds ratio [OR] = 0.75, 95% confidence interval [CI] 0.59 to 0.95).

Engaging in "consistent" cultural activities reduced the risk by 30% (OR = 0.70, 95% CI 0.55 to 0.89).

The following were not associated with health literacy decline:

• consistently reading a daily newspaper (OR = 1.04, 95% CI 0.84 to 1.29)
• consistent civic participation (OR not reported)
• leisure activities (OR not reported)
• social networks (OR not reported)

How did the researchers interpret the results?

The researchers concluded that, "Internet use and cultural engagement, including attending the cinema, art galleries, museums, or the theatre, appear to help older adults to maintain health literacy skills during ageing regardless of cognitive functioning."

Conclusion

The authors say "consistent" use of the internet and cultural engagement helps older adults maintain health literacy skills. But their study has a number of limitations, including:

• Only a brief abstract of this study is available. This provides fairly limited information on the study, which makes it difficult to assess the complete methods.
• No details were provided on the average age of participants. The youngest were only 52 at the start of the study and, as they were only followed up for seven years, a major decline in the ability to read a medicine label seems unlikely.
• Health literacy appears to only have been assessed using the ability to read and understand a medicine label. It did not include the next step advocated by WHO, which is to be able to then use the health information to make good healthcare decisions. No details have been provided on the extent of the health literacy decline in people who did not use the internet or engage in cultural activities, so it is not known whether this would be large enough to be noticeable or clinically important.
• The researchers say engaging in these activities was linked to maintaining health literacy regardless of cognitive function. Unfortunately, because of the lack of details available about the study, it is not clear whether cognitive function was formally assessed, or whether this was repeated at different time points during the study. The researchers report adjusting for cognitive function alongside age, ethnicity and education, but, with only a brief methodology available, it is unclear whether the effects of these and other potential confounders have been fully accounted for. 
• It is not clear what "consistent" use of each of the activities means compared with "never". The participants were divided into these all-or-nothing categories, which is unlikely to be a true reflection of normal life.
• This process was done using a mixture of questionnaires and interviews, which can be subject to recall bias and so may not be entirely accurate. In addition, reading was only considered if it was a daily newspaper, but reading books was not included.
• While the statistical analyses did take some potential confounders into account, many other factors weren't, such as whether the participants were still in employment.

This study does not prove that internet use and cultural activities prevent age-related decline in health literacy.

Still, we would argue that health websites such as NHS Choices can provide an invaluable resource of reliable health information, news, lifestyle advice and links to other useful relevant content.

If you are reading this online, we are obviously preaching to the converted, but you may know an older person who you think would benefit from being taught how to use the internet with confidence.

As well as charities such as Age UK, most local libraries should containdetails of internet training courses.