Older people who are active internet users and who regularly indulge in culture may be better able to retain their health literacy, and therefore maintain good health, suggests research published online in the Journal of Epidemiology and Community Health.

The Institute of Medicine defines health literacy as the degree to which a person is able to obtain, understand, and process basic health information so they can make appropriate decisions about their health.

Low levels of health literacy are associated with poorer self-care, higher use of emergency care services, low levels of preventative care, and an overall increased risk of death.

The most important factor governing a decline in health literacy in later years is thought to be dwindling cognitive abilities as a result of ageing, which gradually dulls the brain functions involved in active learning and vocabulary.

The researchers wanted to find out if regular internet use and engaging in civic, leisure, and cultural activities might help to maintain health literacy skills, irrespective of age-related cognitive decline. They therefore assessed the health literacy skills of almost 4,500 adults aged 52 and older, all of whom were taking part in the English Longitudinal Study of Ageing (ELSA) between 2004 and 2011.

At the start of the study, around three out of four people (73 per cent) had adequate health literacy. After six years, scores fell by one or more points in around a fifth (19 per cent) of people, regardless of their initial score, while a similar proportion improved by one or more points.

There was a link between age and declining health literacy, and being non-white, having relatively low wealth, few educational qualifications, and difficulties carrying out routine activities of daily living.

Poorer memory and executive function scores at the start of the study were also linked to greater decline over the subsequent six years.

Around 40 per cent said they never used the internet or email, while one-in-three (32 per cent) said they did so regularly. Similar proportions said they engaged in civic (35 per cent) and/or leisure (31 per cent) activities over the six-year period.

Almost four out of 10 (39 per cent) said they had regularly engaged in cultural activities, such as going to the cinema, theatre, galleries, concerts or the opera, during this time.

Across all time points, internet use and engagement in civic, leisure, or cultural activities were lower among those whose health literacy declined.

J Epidemiol Community Health 2014;0:1–6. doi:10.1136/jech-2014-204733.