Association Between Health Literacy and Frailty in Older Adults: A Study in Two Brazilian Municipalities

Health literacy (HL), recognized as a modifiable social determinant, influences the autonomy and clinical outcomes of the elderly population, so that low levels of HL contribute to worse health outcomes, including frailty. The objective was to analyze the factors associated with frailty, with a focus on HL, in elderly people from two municipalities in the interior of São Paulo. In this cross-sectional study of 219 elderly individuals (≥60 years) from Jundiaí and Araçatuba, frailty was measured using the FRAIL-BR scale and the Clinical-Functional Vulnerability Index (IVCF-20), and HL was measured using the 14-item Health Literacy Scale (HLS-14). Sociodemographic, clinical, and behavioral variables were included. Bivariate analyses and multinomial logistic regression were performed, with a significance level of 5%. Women predominated (64.8%), with an average age of 71.8 (±7.55). Low HL remained associated with frailty according to the FRAIL scale (OR = 3.66; 95% CI: 1.51-8.85) and the IVCF-20 (OR = 5.65; 95% CI: 1.83-17.44). Other factors common to both scales were advanced age (FRAIL: OR = 4.24; 95% CI: 1.26-14.28; IVCF-20: OR = 28.67; 95% CI: 5.31-154.89) and family dysfunction (FRAIL: OR = 3.67; 95% CI: 1.06-12.68; IVCF-20: OR = 6.81; 95% CI: 1.72-27.06). Living alone and diabetes were associated with the IVCF-20, while depression was associated with the FRAIL scale. This research constitutes the first empirical study conducted in Brazil to provide evidence that low levels of health literacy are significantly associated with frailty in older adults.