style="font-size:15px;"> 185 185. Martínez‐Velilla N, Valenzuela PL, Zambom‐Ferraresi F, et al. Tailored exercise is safe and beneficial for acutely hospitalised older adults with COPD. Eur Respir J. 2020; 56(6). doi:10.1183/13993003.01048‐2020.186 186. Martínez‐Velilla N, Valenzuela PL, Sáez de Asteasu ML, et al. Effects of a tailored exercise intervention in acutely hospitalized oldest old diabetic adults: an ancillary analysis. J Clin Endocrinol Metab. 2021; 106(2). doi:10.1210/clinem/dgaa809.
187 187. Sáez de Asteasu ML, Martínez‐Velilla N, Zambom‐Ferraresi F, Ramírez‐Vélez R, García‐Hermoso A, Izquierdo M. Cognitive function improvements mediate exercise intervention effects on physical performance in acutely hospitalized older adults. J Am Med Dir Assoc. September 2020. doi:10.1016/j.jamda.2020.08.024.
188 188. Brown CJ, Friedkin RJ, Inouye SK. Prevalence and outcomes of low mobility in hospitalized older patients. J Am Geriatr Soc. 2004. doi:10.1111/j.1532‐5415.2004.52354.x.
189 189. Zisberg A, Shadmi E, Sinoff G, Gur‐Yaish N, Srulovici E, Admi H. Low mobility during hospitalization and functional decline in older adults. J Am Geriatr Soc. 2011. doi:10.1111/j.1532‐5415.2010.03276.x.
190 190. de Morton NA, Keating JL, Jeffs K. The effect of exercise on outcomes for older acute medical inpatients compared with control or alternative treatments: A systematic review of randomized controlled trials. Clin Rehabil. 2007. doi:10.1177/0269215506071313.
191 191. Landefeld CS, Palmer RM, Kresevic DM, Fortinsky RH, Kowal J. A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. N Engl J Med. 1995; 332(20):1338–1344. doi:10.1056/NEJM199505183322006.
192 192. Siebens H, Aronow H, Edwards D, Ghasemi Z. A randomized controlled trial of exercise to improve outcomes of acute hospitalization in older adults. J Am Geriatr Soc. 2000. doi:10.1111/j.1532–5415.2000.tb03862.x.
193 193. Artero EG, Lee DC, Lavie CJ, et al. Effects of muscular strength on cardiovascular risk factors and prognosis. J Cardiopulm Rehabil Prev. 2012; 32(6):351–358. doi:10.1097/HCR.0b013e3182642688.
194 194. Sáez de Asteasu ML, Martínez‐Velilla N, Zambom‐Ferraresi F, et al. Inter‐individual variability in response to exercise intervention or usual care in hospitalized older adults. J Cachexia Sarcopenia Muscle. 2019; 10(6):1266–1275.
195 195. Chan D, Cheema BS. Progressive Resistance Training in end‐stage renal disease: systematic review. Am J Nephrol. 2016; 44(1):32–45. doi:10.1159/000446847.
196 196. Cheema BS, Kilbreath SL, Fahey PP, Delaney GP, Atlantis E. Safety and efficacy of progressive resistance training in breast cancer: a systematic review and meta‐analysis. Breast Cancer Res Treat. 2014; 148(2):249–268. doi:10.1007/s10549‐014‐3162‐9.
197 197. Nelson ME, Rejeski WJ, Blair SN, et al. Physical activity and public health in older adults. Med Sci Sport Exerc. 2007; 39(8):1435–1445. doi:10.1249/mss.0b013e3180616aa2.
198 198. Baker MK, Atlantis E, Fiatarone Singh MA. Multi‐modal exercise programs for older adults. Age Ageing. 2007; 36(4):375–381. doi:10.1093/ageing/afm054.
199 199. Sherrington C, Michaleff ZA, Fairhall N, et al. Exercise to prevent falls in older adults: an updated systematic review and meta‐analysis. Br J Sports Med. 2017; 51(24):1750–1758. doi:10.1136/bjsports‐2016‐096547.
200 200. Courel‐Ibáñez J, Pallarés JG, García‐Conesa S, Buendía‐Romero Á, Martínez‐Cava A, Izquierdo M. Supervised exercise (Vivifrail) protects institutionalized older adults against severe functional decline after 14 weeks of COVID confinement. J Am Med Dir Assoc. 2021; 22(1):217–219.e2. doi:10.1016/j.jamda.2020.11.007.
201 201. Liu‐Ambrose T, Donaldson MG. Exercise and cognition in older adults: is there a role for resistance training programmes? Br J Sports Med. 2008; 43(1):25–27. doi:10.1136/bjsm.2008.055616.
202 202. Lamb SE, Mistry D, Alleyne S, et al. Aerobic and strength training exercise programme for cognitive impairment in people with mild to moderate dementia: the DAPA RCT. Health Technol Assess. 2018; 22(28):1–202. doi:10.3310/hta22280.
203 203. Izquierdo, M., Merchant, R.A., Morley, J.E. et al. International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. J Nutr Health Aging 25, 824–853 (2021). https://doi.org/10.1007/s12603‐021‐1665‐8
CHAPTER 8 Health literacy and cultural sensitivity
Nina Tumosa
Health Resources and Services Administration, Rockville, MD, USA
Author’s disclaimer: The views expressed in this chapter are solely those of the author and do not represent the perspectives of the Health Resources and Services Administration or the US Department of Health and Human Services, or the United States Government.
Additional disclaimer: This publication lists non‐federal resources in order to provide additional information to consumers. The views and content in these resources have not been formally approved by the US Department of Health and Human Services (HHS) or the Health Resources and Services Administration (HRSA). Neither the HHS nor the HRSA endorses the products or services of the listed resources.
Introduction
Cultural differences between patient and provider can lead to misunderstandings, value conflicts, and disparate understandings of health and illness. Low health literacy leads to poor understanding and adherence and often limits access to health care. Together, low levels of health literacy and a lack of cultural sensitivity can severely impact health outcomes.1 Dramatic shifts in population demographics may be due to migration or the natural demographic shifts of an ageing society. A dramatic example of the effects of migration on the ethnicity of a population occurred in the United Kingdom (UK). In the 1950s, Bethnal Green, an area in London, was a predominantly white, working‐class neighbourhood. In the 1990s, its name had changed to Tower Hamlet, and it had become the home of large numbers of Bangladeshi immigrants. In 2018, Tower Hamlets had the lowest life expectancy and the highest rate of heart disease in all the London boroughs.
Religion offers another measure of population diversity. Wolverhampton, in the West Midlands, UK, has significant multicultural diversity in religious preference. The population identifies as 55.5% Christian, 19.7% no religion, 9.1% Sikh, 3.7% Hindu, 3.6% Muslim, and 0.4% Buddhist. Language also plays a role in maintaining low health literacy: over 800 languages are spoken in New York City, and Mandarin is the language spoken by the largest number of people worldwide. London, Leicester, Luton, Slough, and Birmingham, UK currently have a greater than 50% ethnic minority population versus a white British majority.
Changes such as these require training programmes for health professionals in how beliefs of different cultures may impact the interactions between older people and their health care providers. These changes have resulted in the need for geriatrics health professionals to be aware of cultural differences between their patients and their varying levels of health literacy. They must also be aware of how these cultural differences and health literacy levels might impact the care that their patients receive and accept.2 For example, older migrants are often non‐adherent with medications, resulting from interactions between illness perceptions, low health literacy, language barriers, and disadvantaged socioeconomic circumstances, which can sometimes restrict the ability to purchase prescribed medications.3
