Among the 11,801 responders of the BRFSS survey, 5,638 participants were asked the specific supplemental questions including the health literacy questions and 5,494 responders answered all three health literacy questions (response rate = 97.5%). Most respondents reported moderate health literacy (61.1%), followed by high health literacy (31.4%), and low health literacy (7.5%). Respondents ≥ 65 years of age represented the second largest proportion of the low health literacy group (7.9%), following 45-54 year olds. young adults and the middle-aged were equally represented in the high health literacy group (Table 1).

With respect to falls self-reported in the prior month, females appear to have a higher estimated mean number of falls than males, although there is a great deal of interaction between location of residence and health literacy levels (Table 2; Figure 1, Figure 2, Figure 3 & Figure 4). For males, the number of falls and injuries decreased with higher health literacy; metropolitan statistical area (MSA) city 1.4 to 0.2, MSA city suburb 1.0 – 0.3, Outside MSA city 1.0-0.5) (Table 2). The place of residence does not appear to significantly affect the number of falls experienced once the standard errors of measurement are taken into account, however, it may be likely that individuals with low health literacy experience more falls, particularly in urban environments. For females, these trends are more difficult to ascertain as many of the estimated profile means have larger standard errors. However, the trends do appear to be consistent with the male findings (Table 2).

With respect to falls that resulted in injury in the prior month, females appear to have a higher estimated mean number of falls than males, although there is a great deal of interaction between location of residence and health literacy levels (Table 2; Figure 1 and Figure 2). For males, the number of falls and injuries decreased with higher health literacy (Table 2). For females, these trends are more difficult to ascertain as many of the estimated profile means have larger standard errors. However, the trends do appear to be consistent with the male findings (Table 2).

This study utilized a three question screening tool as part of the statewide BRFSS survey 9. Study findings reinforces the literature that health status is related to health literacy particularly for older adults 1011. However, limited evidence investigating health literacy and older adults exists. The findings support the importance of addressing fall prevention for older adults. Although a number of viable fall prevention programs have shown promise 121314151617, none of these interventions applied plain language methodology specifically addressing low health literacy. Education about falls, specifically fall prevention, should include materials developed with low health literacy in mind 5. As identified in our study results, fall prevention programs that target the recruitment and education of women and caretakers of female older adults are needed 4. It also appears that interventions in metropolitan areas of Kansas are warranted. Implications for the dual approach of addressing fall prevention and health literacy for the older adult include quality of life, clinician patient communication and treatment compliance. Physician prescribed physical activity is one method that has shown success and may be a viable option for fall prevention interventions for this population 18. Demographic differences in fall rates continue for older adults. Health literacy rates appear to be impacting these demographic characteristics.