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When it comes to the benefits of electronic health records, older Americans may be left behind, according to a new study.

Less than a third of Americans age 65 and over use the Web for health information and barely 10 percent of those with low health literacy – or ability to navigate the health care system – go online for health-related matters, according to the nationally-representative study by researchers at the University of Michigan. Study results appear in the November 2014 issue of the Journal of General Internal Medicine.

“In recent years we have invested many resources in Web-based interventions to help improve people’s health, such as electronic health records designed to help patients become more active participants in their care. But many older Americans, especially those with low health literacy, may not be prepared for these new tools,” said lead author Helen Levy, Ph.D., research associate professor at the U-M Institute for Social Research in a press release.

“Our findings suggest that there’s a digital divide when it comes to health care. Older adults with low health literacy especially represent a vulnerable population that’s at high risk of being left behind by the advance of technology.”

Over the last 5 years, use of electronic health records in the U.S. has increased dramatically as a result of government initiatives and investment by healthcare providers. Many providers now offer patients access to parts of their own medical records via online health portals that include everything from reminders of when they are due for wellness visits and screening tests, to immunization records and lab results, as well as key information on obtaining and using their prescription medications correctly and safely.

“Health information technology promises significant benefits, but it also comes with the risk that these benefits won’t be shared equally,” said senior author Kenneth Langa, M.D., Ph.D., professor of Internal Medicine at the U-M Medical School and research investigator at the Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System.

“The Internet is becoming central to health care delivery, but older Americans with low health literacy face barriers that may sideline them in this era of technology. Programs need to consider interventions that target health literacy among older adults to help narrow the gap and reduce the risk of deepening disparities in health access and outcomes.”

Regular readers of HealthCetera may be familiar with previous stories about the need for health systems and organizations to address issues of health literacy and digital divide — especially among the older population. Digital literacy has been associated with slower cognitive decline, enable more people to age healthy at home, improve decision making, and facilitate care coordination. Older adults are eager, willing, and able to learn about technology, just ask the seniors featured in our report about the Senior Planet technology center.

However, educational and income disparities — huge drivers of poor health literacy —  continue to be a hurdle many seniors can’t overcome. Policymakers, clinicians and community service organizations must pay closer attention to e-health literacy interventions targeting the needs of older adults, before more older adults slip even further behind.

Liz Seegert, Senior Fellow

When it comes to the benefits of

This post is by CHMP’s graduate fellow, Amanda Anderson, RN.  Amanda is a practicing bedside nurse in Manhattan, and a grad student at the Hunter-Bellevue School of Nursing, where she co-directs The Nurses Writing Project. Her personal site, This Nurse Wonders, hosts her writing, and she tweets @12hourRNfile0002101523869

It’s been a strange week for nurses in the media, to say the least. We were present, but our crowning achievement – an M&M-throwing parody on SNL – isn’t exactly one for the history books. While our ability to entertain rang through the web, our titling in print stayed true to its baseline. Sure, a reporter or two mentioned going the extra mile to get our quotes, but their pavement pounding (or biking), didn’t seem to reach our far-off doors.

Or did it?

This week, I was dismayed to read not one, but three articles on a topic that is familiar to every nurse’s practice: Falls. I realize that my experience is limited to the horrible occurrence of finding a patient on a hospital floor, but I believe it’s safe to say that each nurse caring for a patient has their own version of care, and knowledge of prevention, when it comes to this topic.

My first few passes through these articles, written by a woman named Katie Hafner, proved bereft of nurse voice. Again, a huge article on a topic that is largely nurse-centric, written without a single quote from a member of our profession. In reality, our interventions to prevent and treat falls are paramount, and our profession produces scores of practice-defining research on the topic – why no word from us here?

In my frustration, I decided to reach out to the author. I asked her if she was unaware of recent nursing research related to falls? Had she missed a nurse-led initiative by the Robert Wood Johnson Foundation to implement fall-reduction protocols in hospitals, or a recent article in The American Journal of Nursing, where nurses and physical therapists discuss a mobility program, aimed at halting fall-inducing deconditioning? Did she try any of the San Francisco hospitals or care facilities that she referenced, for a quote from a clinical nurse specialist or nurse educator about their current initiatives to prevent and treat falls?  Did she know that each bedside nurse, the first line of prevention for a falling patient, could offer insight and experience into how we daily screen each of our patients for falls, as per federal requirements?

Perhaps my questions were too pointed, because she replied with prompt and wholehearted affirmation – falls could certainly not be spoken of without nurse input. So why no sourcing? She had spoken with MANY nurses, she said. Two of which – both prominent researchers on the topic – were cited in one of her pieces.

Huh?!

I went back to her pieces, scouring for the sources she spoke of. Sure enough, I found them, halfway through – Dr. Pat Quigley and Dr. Dorothy Baker. But Dr. Baker, an accomplished nurse practitioner, was just, “a research scientist” recommending chats with primary care physicians, and Dr. Quigley, a celebrated and highly credentialed nurse practitioner, clinical nurse specialist and Fellow of the American Academy of Nursing was simply, “a falls prevention expert,” advocating for the replacement of sleeping pills with warm milk.

I’ll admit to my initial oversight, but I wanted further explanation of its cause from Hafner. Why had she titled these nurses this way, stripping them of their foundational specialization? Had they asked for their otherwise prominently listed nursing credentials to be nixed for the piece? I received a fascinating and equally frustrating response: She, like any good reporter, had listed them exactly the way that they had requested.

This news is saddening to me, and surprising. Why would researchers who built their careers on a foundation of nursing experience, distance themselves from it in the media? Apparently this phenomenon isn’t rare, and brief conversations with scholarly editors and health care journalists attest to this. Joy Jacobson, former managing editor of The American Journal of Nursing, and frequent contributor, says many of her nurse sources aren’t just hard to find, they’re reluctant to speak openly for lack of support, and fear of saying something that might make them lose their funding or jobs. Others hypothesize that academic nurses want to distance themselves from a profession scarred with stereotypes and oft-poorly spoken advocates.

While we’re likely not the easiest sources to locate – a quick Google of “doctor + Manhattan + Ebola” provided far more than a search substituting nurse as provider – I think much of our media absence must be caused by our lack of knowledge on how to speak effectively for ourselves, and our lack of support in doing so. Because we are afraid or unsure of our words, we silence ourselves to the public, just like we silence ourselves at our own dinner tables – no one wants to hear of the gross things I do, anyway, we often say.

This all too familiar sentiment – one that seems to plague even those at the top of the professional ladder – must be fought with work and study. Programs exist – Diana Mason & Barbara Glickstein’s media training is nationally renowned, and the organization Working Narratives, offers multiple resources on storytelling and social change – both great places to start.

Our profession will continue to be ridiculed and misunderstood if we don’t speak up and claim it in a unified, trained voice. While Baker and Quigley requested to leave their “RNs” out of print, Kaci Hickox, regardless of the correctness of her quarantine choices, was stripped of her many professional distinctions this week, titled simply, “NURSE.” I haven’t spoken with any of these nurses, and don’t know the full story behind their titling choices or blunders. But I wonder if, in the end, they’re all the same, all falling into Jacobson’s cutting assessment of nurses as sources: “They have an unparalleled perspective on what really goes on in health care, and to survive, they feel, they have to keep it to themselves.”

This post is by CHMP’s graduate fellow,

HealthCetera’s Health News is CHMP’s weekly news update produced for WBAI’s Morning Show on 99.5 FM. Today’s segment covered how Americans voted on health care issues; Science and health writer, Sonya Collins, article on WebMD.com, “Immunotherapy Brings New Hope to Cancer Fight” and New York City Council and The New York Academy of Medicine’s expansion of the Council’s Age-friendly initiative by establishing Age-friendly Neighborhoods in 10 new districts.

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