Tip Sheets

How to help an older audience get the most value from your reporting

By Liz Seegert

Most journalists do a great job of writing for their audience. However, sometimes it’s easy to forget that part of the audience may include older adults – who often struggle with issues of health literacy, cognitive impairment or language problems.

As Medicare Open Enrollment season gets underway, this is a good time to consider story structure and how the information seniors may rely on is framed. While most of these tips probably are more applicable to journalists at consumer media, writers for more specialized journals and outlets can also benefit.

Processing health information

Health literacy difficulties affect more than 77 million U.S. adults, including the growing senior population, according to the U.S. Department of Health and Human Services. Poor health literacy can compound already challenging health problems. It also is exacerbated by cognitive decline, medication side effects and lack of knowledge about the health care system.

Even those with good general literacy skills — that is, how well a person obtains, processes, and understands information — can struggle with health information.

Nearly everyone struggles with health literacy at some point. The U.S. Department of Education estimates that 90 percent of adults age 16 and older have health literacy challenges. Those age 65 and older have lower average health literacy than adults in younger age groups.

As the U.S. health system evolves toward more patient-centric, outcomes-driven care, and with patients now asked to take a more active role in decision making, the ability to understand, interpret, and act on health information is more vital than ever.

We already know that people with lower health literacy are less likely to manage chronic diseases effectively, have more issues with medication compliance, and rely more on emergency departments to get care. The Institute of Medicine’s landmark report, Health Literacy: A Prescription to End Confusion, analyzed the problem and called on health systems to “develop and support programs to reduce the negative effects of limited health literacy.” As the aging population continues to increase, it makes sense that media organizations and journalists also bear this advice in mind.

How Seniors Get Health News

Older adults are voracious consumers of news, including health news. According to a American Press Institute study, 93 percent of older adults report they enjoy keeping up with the news, and are also more likely to report reading, watching, or hearing a news story in-depth in the last week. In addition:

  • Older adults are more likely to rely on traditional television, radio, and print media for their news than are those in the youngest adult cohort

  • 95 percent of those 60 plus report getting their news from TV in the past week, compared with 76 percent of younger adults.

  • Older adults are also most likely to get news in print compared with younger adults (75 percent of those 60 years-plus, versus 61 percent of adults ages 40-59, 55 percent of adults age 30-39, and 47 percent of adults age 18-29).

Many seniors are less likely to turn to new media for health news, according to these additional statistics:

  • A University of Michigan study showed that less than one-third of Americans age 65 and older use the Internet. Among older adults, only 10 percent of those with low health literacy, or who lack the ability to navigate the healthcare system, go online to research health-related matters.

  • Pew Research reported that about four-in-ten adults ages 65 and older (39 percent) do not use the Internet, compared with only 3 percent of 18-to-29-year-olds.

  • The U.S. Department of Education reported that 80 percent of adults with below basic health literacy skills reported getting none of their health care information from the Internet.


Photo: Condoriano via Flickr

What Can Journalists Do?

Most health information, (print, websites, etc.) is written at a 10th-to-15th grade level and higher, according to Christina Zarcadoolas, Ph.D., of the CUNY School of Public Health at Hunter College. So journalists may want to consider modifying their approach, rephrasing or toning down some of the language when a story is especially relevant to an older audience.

“To communicate effectively with older adults about health issues, it is important to use language they are likely to understand and lots of dramatic examples that they can relate to,” Gary L. Kreps, Ph.D., director of the Center for Health and Risk Communication at George Mason University, said in a direct-message interview. “This way you can increase their attention to, comprehension of, and recall of health messages. In addition, by providing specific achievable recommendations you can also increase the influences of your messages on health behaviors and health outcomes.”

Reporters love to use data and charts, but according to the National Library of Medicine, among those who struggle with low health literacy:

  • 80 percent have difficulty using forms or charts

  • 68 percent have difficulty interpreting numbers & performing calculations.

  • Two-thirds are unable to understand prescription information.

The National Institutes of Health points out that as people age there may be changes in how they read and interpret information. Older people may have to work harder to:

  • Process information quickly, such as recalling new facts and interpreting charts.

  • Understand text that is densely packed with new ideas or contains complex syntax.

  • Draw inferences.

  • Solve new problems.

  • Manipulate different types of information at the same time.

  • Focus on important new information without being distracted by irrelevant details.

Older adults also may be less able to change their long-held opinions to accept new information, a skill that scientists call cognitive flexibility.

In addition, older adults may have a hard time remembering the context or source of information. So over time, false or incorrect statements may be remembered as true, simply because the information seems familiar. This is called the "illusion of truth" effect.

For example, if you write "Many people mistakenly think that exercise is unsafe for older adults; that it causes more harm than good," your intent is to dispel incorrect information. But over time, an older reader may forget the context and simply remember that exercise was somehow connected to being unsafe. As a result, he or she doesn't exercise – the opposite of what you intended.

References to online tools or resources can pose challenges for older adults too. This story from Southern California Public Radio highlights some of the issues that people on Medicare and other at-risk populations can experience with electronic health portals.

When writing for an older audience, the NIH recommends:

  • Be direct and specific. Present information in a clear and familiar way to reduce the number of inferences that must be made. If your suggestions are by necessity general, like "Eat healthier foods," as the National Institute on Aging advises, then try to give specific examples.

  • Omit unnecessary words. For example, instead of saying, "Some people find that talking to their health care provider can be helpful when deciding how to care for their hypertension," you might say, "Talk with your doctor about managing your high blood pressure."

  • Limit the number of key points. Try to stick with three to five takeaways per story. Make your message brief to help compensate for possible short-term memory limitations.

  • Offer a manageable number of action steps. There may be several things you want your readers to do about a certain health issue. However, some older readers may have a hard time implementing several tasks all at once.

  • Try to suggest only one or two things at a time. For example, a story about sun safety could offer plenty of possible health recommendations. But sticking with only a few suggestions increases the likelihood that an older reader will actually take action.

  • Consider presenting suggestions as carefully numbered, sequenced steps. People with some cognitive disorders, such as early Alzheimer's disease, typically can retain only one or two steps at a time. (Check out this AHCJ tip sheet for reporting on Alzheimer’s and other dementias).

  • Use positive statements. Counter the "illusion of truth" effect by always framing your statements positively, as in, "Visit your dentist regularly even if your teeth feel fine," compared with "Do not avoid going to the dentist because your teeth are fine."

  • Say what the reader can do. Focus on actions. For example, "Keep track of your medications," is clearer than "It is important for people to keep track of the medications they take." Another example, "Quit smoking. You reduce your risk for disease," is better than "Quitting smoking has been found effective for reducing risk of disease."

  • Support information with real examples and relatable stories. Using stories can help older readers build on information that is already familiar to them. Examples and stories may connect readers to applicable past experiences. Avoid using abstract examples that may not seem clearly relevant.

  • Use simple graphics to help illustrate information. Sometimes an easy-to-understand visual can help the reader identify with the information. For example, when explaining a medical procedure, it may be helpful to include an illustration of it.

  • Reinforce main points with questions. Research suggests that inserting questions related to the main messages into the text may help readers to recall key points.

  • Avoid complex diagrams. Charts and graphs that require interpretation or the ability to compare information in different rows or columns can be confusing for older readers.

  • It should go without saying: avoid medical jargon whenever possible. If medical terminology cannot be avoided, include an easy-to-understand definition.

Over a decade ago, this article in Health Affairs noted that “health literacy is central to multiple health system priorities, including quality, cost containment, safety, and patients’ involvement in health care decisions….Active, health-literate consumers can go online and get the latest information on sophisticated technological innovations; they create demand for the latest technology. Patients with low literacy sit on the other side of the digital divide and are not able to function as informed consumers.” Today, this message is more pertinent than ever.

Resources

  • CMS Toolkit — while originally created to guide development of communications like brochures, many of the suggestions are also applicable to journalism.

  • Life-Span Communication by Loretta L. Pecchioni, Kevin B. Wright, Jon F. Nussbaum — see the chapter on mass communication and the elderly

  • This article from the HHS Office of Disease Prevention and Health Promotion with health literacy tips for health websites.

Experts

Rima E. Rudd, MSPH, ScD
Senior Lecturer on Health Literacy, Education and Policy, Harvard T.H. Chan School of Public Health
Phone: 617.432.3753
rrudd@hsph.harvard.edu

Cynthia Baur, Ph.D. Senior Advisor, Health Literacy
Centers for Disease Control and Prevention
Cynthia.bauer@cdc.hhs.gov

Gary L. Kreps, Ph.D., FAAHB, University Distinguished Professor, Department of Communication, and Director, Center for Health and Risk Communication at George Mason University, Virginia.
gkreps@gmu.edu
703.993.1094