遥遥领先冰山一角：老年人的健康素养

nant of health, Nutbeam and Lloyd (2021) reported strong evidence of a social gradient in population-based studies. Health literacy is increasingly being seen as a better predictor of health than many other social determinants of health including, ethnicity, education and employment status. Indeed, if not one of the strongest predictors of health, health literacy has become the strongest social determinant of health (Ho & Smith, 2020).

2 COVID-19 AND HEALTH LITERACY IN OLDER PEOPLE

The importance of health literacy in older people has been illustrated by the COVID-19 global pandemic. Although all age groups are at risk of contracting the COVID-19 virus, older people are more vulnerable to mortality and morbidity associated with the viral infection (Smith et al., 2020). The emergence of the COVID-19 pandemic provided a critical test for health literacy, giving it the opportunity to highlight its importance in relation to population health and well-being. Governments and health providing agencies around the world would appear to be increasingly aware that population-based enhancement of health literacy may be equated with decreased health inequalities and improved health outcomes. To date, there is a paucity of research which specifically addresses the impact of low health literacy in older people during the global pandemic. It could be potentially rationalised through Sorensen’s integrated model of health literacy, hypothesising that lower levels of health literacy may be associated with sub-optimal levels of empowerment in health behiour (Sørensen et al., 2012). The potential benefits of enhanced health literacy in older people are vast, perhaps now is the time to re-evaluate perspectives of health literacy research in older people. In this editorial, we will highlight the importance of the nursing role in health literacy, consider challenges in nurse education, critique approaches towards health literacy assessment and highlight the potential links that may exist between health literacy empowerment and resilience.

3 IMPORTANCE OF NURSING IN HEALTH LITERACY FOR OLDER ADULTS

Regardless of caring environment, hospital or community-based, nursing staff are key providers of patient education and health-related information. Therefore, it is somewhat surprising that although the nursing profession shoulders most of the responsibility for the delivery of health-related patient education, limited global attention has been given to nursing awareness, knowledge and application of health literacy, especially in the care of older people. Despite this, the provision of shame-free health literacy support for older people has been associated with greater levels of empowerment, engagement, activation and optimal health-related outcomes (Loan et al., 2018). Regardless of nursing specialty, health literacy is an essential skill that enhances effective communication and aids in the provision of person-centred care for older people, potentially reflected by increased patient satisfaction of care.

High-quality research is essential, to ensure effective evidence-based health literacy practice. Whilst fully appreciating the need to explore the role of illness and cognition in the health literacy of older, more emphasis could be placed on the determinants and correlates of health literacy. We view the importance of clearly defined terms and the use of valid measurement tools as the basic requirements in any research that aims to understand the role of health literacy in older people.

Healthy and successful ageing is important, perhaps more attention could be given towards the assessment of issues that may be more meaningful to the older person, such as physical activity and diet, these may enhance the quality of life of the older person and ensure that they are in a better position to make and act health-related preferences and decisions upon these day-to-day activities. There is clearly scope for more nursing research to help to identify barriers and facilitators for the delivery of appropriate and effective health literacy practices. Now may also be an opportune time to develop important longitudinal studies that explore the relationship between health literacy and health-related outcomes in older people.

4 HEALTH LITERACY AND NURSE EDUCATION

Over a decade ago, writing in the Journal of Clinical Nursing, Scheckel et al. (2010) highlighted the importance of health literacy education. They specifically advocated for novel approaches towards the instruction of health literacy in the nursing profession, stressing that dedicated teaching in the practice of health literacy would expand students’ existing skills and knowledge in preparation for their professional practice. To date, despite its importance, not all nursing educational institutes would appear to subscribe to this educational approach. The inclusion of health literacy-related questions in all formats of nursing assessment may provide a good starting point. Students could be encouraged to ask open-ended questions and using ‘teach-back’ methods when providing health-related information to older people. Using the ‘teach-back’ approach helps to validate that the nurse has provided information in an understandable format, patient understanding can be verified when they can restate the information in their own words. The value of the ‘teach-back’ approach is that it can empower nurses to authenticate understanding and correct erroneous information with older people. Despite the development of several promising nursing health literacy initiatives since Scheckel’s work, providing innovative solutions and strategies, it is thought that many of these he been grossly under-utilised by the profession (Loan et al., 2018).

With a global ageing population, now is the time to give more attention to the education-related health literacy research for older people in society. Developing educational approaches in health literacy for all undergraduate nursing students, based upon sound evidence, may be the best way forward to ameliorate and allay against problems and provide a path towards promoting a healthier ageing process. From a post-registration perspective, the establishment of strategic competency-based health literacy education may enhance the health literacy professionalism of nurses. Due to the fast-changing and dynamic nature of health literacy, these initiatives for older people are required as a matter of urgency.

Getting older is not in itself a barrier to being able to source the Internet or other forms of computer-based technology, like telemedicine services. Increasingly, older people are accessing vast amount of health-related information is ailable, although carefulness needs to be taken in relation to the reliability and dependability of some of this information. Digital health literacy is increasingly playing an important role. To enhance the ability of older people to use the Internet, age-related changes in vision and cognition health-related websites need to be considered when specifically designing material for older people. Failure to do so may affect the accessibility of Internet for older people due to potential limitations of working memory, perceptual speed, text comprehension and spatial memory. All forms of health-related information could be made more user-friendly by using an appropriate typeface, writing style, nigational composition and accessibility.

Around the world, nurses should not only be aware of the potential problems associated with health illiteracy in older people, but they should also be able to actively try to remedy the situation. Unlike socio-demographic characteristics, like age and ethnicity, which are non-modifiable, there is reasonable evidence to suggest that levels of health literacy can be modified and enhanced in older people. Health literacy interventions could be designed to directly tackle the cognitive difficulties, which may limit older people’s ability to access and understand health-related information. To date, most e-interventions for improving levels of health literacy in older people he focused on reducing the cognitive demands, usually involving increasing the readability of materials or to ensure that assistance is being provided by an appropriate member of healthcare staff. Nurses working with older people should he an awareness of the potential benefits of relatively straightforward approaches that can be taken to address health literacy deficits, including using plain language and non-jargonistic terms when delivering health-related information. Attending to these basic prerequisites may be effective to facilitate the understanding of older people, potentially enhancing empowerment and resilience.

Patient-centred approaches to health literacy place a focus on identifying an individual’s knowledge, motivation and skills to gain, comprehend and apply health-related information. In general, this approach to communication is encouraged, especially when dealing with health literacy issues in older people.

5 ASSESSMENT OF HEALTH LITERACY IN OLDER PEOPLE

Developing health literacy interventions is one aspect of the research process, however, measurement of health literacy is also required, and this has been known to be a demanding process. Identifying low levels of health literacy is clearly important in older people; however, there is some debate around the best way to capture this complex and dynamic concept. Historically, researchers he applied objective measures, like the Rapid Estimate of Adult Literacy in Medicine (REALM), within older people research. Since then, more comprehensive subjective measurement tools he emerged. One of these, the HLS-EU, originally developed and validated in Europe is now used widely around the world. The European Health Literacy Survey Questionnaire (HLS-EU) provides the researcher with a scale which is focused on task-specific competencies, such as illness prevention and health promotion, potentially important in capturing vital aspects of active ageing in the assessment of health literacy in older . More recently, other measures he surfaced which capture important aspects of age-specific conditions, like dementia literacy.

6 EMPOWERMENT AND RESILIENCE

The World Health Organization has promoted the importance of the role of health literacy in the development of empowerment and resilience in older people (WHO, 2013). Empowerment is seen as a process through which people gain more control over their lives, their health and its determinants. Through empowerment, health literacy programmes contribute to democratising the healthcare system and to achieving a stronger commitment to health and well-being in communities and in society at large. Resilience is viewed as a form of adaptation, recovery and ‘bouncing back’ in the face of adversity. In relation to both traits, health literacy is viewed as an asset for individuals and communities, as such, any investment that is made to strengthen health literacy in older people may yield a substantial return in enhanced health and well-being. In conjunction with appropriate social resources, health literacy can become an valuable asset that will help to support older people to become more empowered and resilient for active ageing. Presently, we believe that there are significant research gaps in the area of health literacy in older people, including scope for up to date systematic reviews, examining the relationship between health literacy, resilience and empowerment in older people.

7 SUMMARY

It was the aim of this editorial to capture the most relevant nursing aspects of health literacy in older people. As stated, we believe the health literacy has become one of the most important determinants of health in older people, which can be considered as a modifiable element of socioeconomic inequalities in health. Increasingly, evidence suggests that health literacy mediates the relationship between socioeconomic standing and health inequalities.

Therefore, health literacy has the potential to improve health outcomes and may prove to be decisive in the development of resilience and empowerment in the world’s older population. Nurses should be instrumental in enhancing levels of health literacy in older people and greater attention needs to be given to age-specific aspects of health literacy in older s in nurse education.

As the title of this editorial indicates, we speculate that the issue of health literacy in older people may be likened to that of the iceberg model, only part of the problem is readily seen, perhaps those with age-related disorders, the majority remain hidden beneath the surface. We believe that nurses are in an ideal position to play a vital role in identifying and tackling the health literacy-related issues of those in the latter group.

全文翻译成（仅供参考）

1 介绍

为数众多快速增长加剧孩童愈发必需获得医疗保障服务、健康资讯和英语教育，以识别和处理意味著与凋亡关的的健康关的应对办法。快速增长还会减少各种因素的几率，这会受到影响贫困恒星质量和健康。牙医多半并能从不同的尺度阶级斗争性地分析孩童的各种因素，以外健康自主性，这是自我保健和健康举动的可变动密切关的。尽管人们愈发想到健康自主性的必要性，但辨认出对孩童这一本质的非议极小，这某种程度有点难以置信。健康自主性可以从公共健康的尺度表述为“与自主性关的联，必需人们获取、阐释、几率评估和应用领域健康资讯以在日常贫困中会无论如何有关医疗保障、哮喘健康保健和健康的判断和暂时的科学知识、用意和能意志力。加强在生命操作过程中会保持稳定或改善贫困恒星质量”（Sørensen 等人，2012 年，第 3 页）。在孩童中会，孩童的健康自主性极低与健康和健康结果的次优准确度有关，例如对治疗可行性的依从性、药品依从性和自我管理能意志力。健康自主性极低意味著与较差的健康现况和贫困恒星质量毁损直接关的。在生物病理学静态中会，孩童健康自主性极低下的大多数与年龄组关的的应对办法都可以用本质能意志力的相似之处来解释，以外与习惯凋亡分析方法相一致的思维操作过程的运动速度。从观念学的尺度来看，健康自主性被普遍认为健康的潜在观念密切关的，可以应对健康不公正应对办法。为了将健康自主性本质化为健康的观念密切关的，Nutbeam 和 Lloyd（2021）报告了基于人群的数据分析中会观念梯度的有意志力证词。健康自主性愈发被普遍认为比许多其他健康应对办法观念密切关的（以外种族主义、英语教育和就业现况）较好的健康假设基准。事实上，即使不是健康的超强假设基准之一，健康自主性也已带进健康的超强观念密切关的（Ho & Smith，2020）。

2 COVID-19 和孩童的健康自主性

COVID-19 为数众多大流行证明了孩童健康自主性的必要性。尽管所有岁数都有感染 COVID-19 大肠杆菌的几率，但孩童可能会死于与大肠杆菌感染关的的致死率和存活率（Smith 等，2020）。COVID-19 大流行的消失为健康自主性备有了最主要考验，使其有机遇务实其对人故名健康和造福的必要性。为数众多的政府和健康备有私人机构无论如何愈发想到，以人故名进一步将的健康自主性进一步提高意味著等同于减少健康不公正和改善健康结果。为数不多，缺乏专门从事针对为数众多大流行后曾孩童健康自主性极低下的受到影响的数据分析。可以通过 Sorensen 的健康自主性综合性静态将其合理化，假设极低的健康自主性准确度意味著与健康举动中会的次优准确度有关（Sørensen 等，2012）。进一步提高孩童健康自主性的潜在好处是巨大的，某种程度从前是重新几率评估孩童健康自主性数据分析前景的时候了。在这篇社评中会，我们将务实保健在健康自主性中会的必要性，考虑牙医英语教育中会的挑战，阶级斗争健康自主性几率评估的作法，并务实健康自主性催生和以后意志力之间意味著共存的潜在联络。

3 保健对孩童健康自主性的必要性

无论在何种保健环境污染、医院或社区，保健工作人员都是病征英语教育和健康关的资讯的主要备有者。因此，尽管保健各个领域承担了备有与健康关的的病征英语教育的大其余部分责任，但为数众多对健康自主性的保健意识、科学知识和应用领域的非议极小，相比较是在孩童的保健层面，这有点有点难以置信。.尽管如此，为孩童备有无耻的健康自主性赞成与更为高准确度的催生、参与、触发和最佳健康关的结果关的（Loan 等，2018）。无论保健各个领域如何，健康自主性都是一项离不开的战技，可减弱有效交谈并有助为孩童备有知行合一的保健，这意味著反映在病征对保健满意度的进一步提高上。

高恒星质量的数据分析是离不开的，以确保安全有效的循证健康自主性该系统化。在充分意识到必需追寻哮喘和本质在孩童健康自主性中会的起到的同时，可以非常重视健康自主性的密切关的和关的原因。我们将明确表述的词语和用作有效探测工具的必要性普遍认为意在了解孩童健康自主性起到的任何数据分析的也就是说要求。

健康和成功的快速增长很最主要，某种程度可以更为多地非议几率评估对孩童难以实现的应对办法，例如体育运动活动和饮食，这些可以进一步提高孩童的贫困恒星质量并确保安全他们并能较好地对这些日常活动无论如何与健康关的的比如说和暂时并施加压力。只不过有更为多的保健数据分析可以尽力明确持续性和加强原因，以备有必需和有效的健康自主性该系统化。从前也意味著是开展最主要的纵向数据分析以追寻孩童健康自主性与健康关的结果之间人关系的好时机。

4 健康自主性和牙医英语教育

十多年前，Scheckel 等人在《流行病学保健Magazine》上文章。(2010) 务实了健康自主性英语教育的必要性。他们特别提倡保健各个领域健康自主性教研的新作法，务实健康自主性局限性会的专门从事教研将引入学校既有的战技和科学知识，为他们的各个领域该系统化做到准备。为数不多，尽管它很最主要，但并非所有保健英语教育私人机构无论如何都拥护这种英语教育作法。在所有表达方式的保健几率评估中会举例来说与健康自主性关的的应对办法意味著是一个很好的西端。在向孩童备有与健康关的的资讯时，可以鼓励学校提出开放式应对办法并用作“PID”作法。用作“PID”作法有助有效性牙医应该以可阐释的格式备有了资讯，当病征可以用自己的客家话重述资讯时，可以有效性他们的阐释。“PID”作法的重要性在于，它可以使牙医并能有效性孩童的阐释并有错错误资讯。尽管自 Scheckel 的工作以来发展了几项有前途的保健健康自主性原计划，备有了创新的应对可行性和方式而，但人们相信其中会许多被该从业者严重借助（Loan 等人，2018 年）。

随着为数众多人故名快速增长，从前是时候非常非议观念中会孩童的英语教育关的健康自主性数据分析了。根据合理的证词，为所有本科保健各个领域学校制订健康自主性英语教育作法，意味著是改善和缓解应对办法的最佳途径，并为加强更为健康的快速增长进程备有途径。从注册后的尺度来看，建起以战略思想能意志力进一步将的健康自主性英语教育可以提升牙医的健康自主性各个领域准确度。由于健康自主性的快速变化和动态性质，这些针对孩童的举措是当务之急。

变老本身并不是获取互联网或其他表达方式的基于计算机的技术（如远程医疗服务）的持续性。愈发多的孩童即将采访大量比如说的健康关的资讯，尽管必需严厉对待其中会一些资讯的通用性和通用性。数字健康自主性即将把握愈发最主要的起到。为了进一步提高孩童用作互联网的能意志力，在专门从事为孩童设计者材料时，必需考虑与年龄组关的的视意志力和本质健康关的Facebook的变化。由于工作心灵、知觉运动速度、文本阐释和紧致心灵的潜在限制，否则不会受到影响孩童对互联网的采访。通过用作必需的字体、书写风格、导航在结构上和可采访性，可以使所有表达方式的健康关的资讯非常用户友好。

在为数众多，牙医不仅某种程度想到与孩童健康文盲关的的潜在应对办法，而且还某种程度并能积极试图有错这种情况。与年龄组和种族主义等不可变动的观念人故名外观上不同，有合理的证词证明，孩童的健康自主性准确度可以变动和进一步提高。可以设计者健康自主性偏袒措施来直接应对本质困难，这不会限制孩童获取和阐释与健康关的的资讯的能意志力。为数不多，大多数带电粒子偏袒措施

进一步提高孩童健康自主性准确度的着重是降极低本质需求量，多半限于进一步提高材料的可读性或确保安全由必需的医疗保障工作人员备有尽力。与孩童一起工作的牙医某种程度想到可以采取相对简便的作法来应对健康自主性不足的潜在好处，以外在备有与健康关的的资讯时用作简便的语言和非行客家话词语。满足这些也就是说的关键在于不会有效地加强对孩童的了解，从而有意味著减弱催生和完好无损意志力。

以病征为中会心的健康自主性作法侧重于识别其所获取、阐释和应用领域健康关的资讯的科学知识、用意和战技。有时候，鼓励这种文化交流方式，相比较是在处理孩童的健康自主性应对办法时。

5 孩童健康自主性几率评估

联合开发健康自主性偏袒措施是数据分析操作过程的一个层面，但是，还必需量度健康自主性，众所周知，这是一个要求高的操作过程。识别极低准确度的健康自主性对孩童来说只不过很最主要；然而，围绕猎杀这个十分复杂而动态的本质的最佳方式共存一些争论。从历史背景上看，数据分析工作人员在孩童数据分析中会应用领域了客观量度标准，例如孩童病理学文盲率快速有约 (REALM)。早先，消失了更为新一轮的主观探测工具。其中会之一，最初在欧洲联合开发和有效性的 HLS-EU 从前在为数众多广泛用作。欧洲健康自主性调查题目 (HLS-EU) 为数据分析工作人员备有了一个加权，该加权集中精力于特定执行的能意志力，例如哮喘健康保健和健康加强，这对于在几率评估健康自主性时猎杀出名快速增长的最主要层面意味著很最主要。孩童。已经有，消失了其他量度特定年龄组现况的最主要层面的措施，例如痴呆症文盲率。

6 催生和韧性

世界健康组织已经宣传健康自主性在孩童催生和充分利用能意志力发展中会的必要性（WHO，2013）。催生被普遍认为一个操作过程，通过该操作过程人们可以较好地掌控自己的贫困、健康及其密切关的。通过催生，健康自主性原计划有助借助于医疗保障该系统的民主化，并在社区和整个观念中会借助于对健康和造福的更为有意志力的承诺。韧性被普遍认为一种充分利用、以后和在逆境中会“震荡”的表达方式。就这两个外观上而言，健康自主性被普遍认为其所和社区的财产，因此，任何为加强孩童健康自主性而进行的投资都意味著在减弱健康和造福层面造成了可观的回报。与必需的观念人力独创，健康自主性可以带进一项丰厚的财产，有助赞成孩童在积极快速增长层面变得更为有能意志力和充分利用意志力。目前，我们相信孩童健康自主性领域共存关键数据分析空白，以外最新该系统高度评价的覆盖范围，数据分析孩童健康自主性、完好无损意志力和催生之间的人关系。

7 总结

这篇社评的目的是猎杀孩童健康自主性最关的的保健层面。如前所述，我们相信健康自主性已带进孩童健康的最最主要密切关的之一，可以将其普遍认为健康层面观念农业不公正的一个可变动原因。愈发多的证词证明，健康自主性在观念农业地位和健康不公正之间起到中会介起到。

因此，健康自主性具有改善健康结果的潜意志力，并意味著被证明对世界孩童故名的完好无损意志力和催生的发展具有关键性起到。牙医某种程度有助进一步提高孩童的健康自主性准确度，在牙医英语教育中会必需更为多地非议孩童健康自主性的特定年龄组层面。

正如这篇社评的标题所证明的，我们推断出孩童的健康自主性应对办法意味著被称之为波涛静态，只有其余部分应对办法是显而易见的，某种程度与年龄组有关的哮喘，大多数仍然是隐匿的表面这样一来。我们相信，牙医处于理想的位置，可以在识别和应对后都由工作人员的健康自主性关的应对办法层面把握最主要起到。

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