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Associations Between Working Memory, Health Literacy, and Recall of the Signs of Stroke Among Older Adults

Ganzer, Christine A.; Insel, Kathleen C.; Ritter, Leslie S.

Journal of Neuroscience Nursing: October 2012 - Volume 44 - Issue 5 - p 236–243
doi: 10.1097/JNN.0b013e3182666231

ABSTRACT Stroke remains a major cause of mortality and disability among older adults. Although early treatment after stroke is known to reduce both mortality and disability, the first step in seeking early treatment is dependent on the rapid recognition of the signs of stroke. Recall of the signs of stroke may be dependent on factors that exist before the stroke itself. Although it is known that both working memory and health literacy decline with advancing age, these factors have not been thoroughly examined with respect to recall of the signs of stroke. Therefore, the purpose of the current study was to investigate associations between working memory, health literacy, and recall of the signs of stroke among older adults. Community dwelling older adults (≥65 years of age) were recruited from two senior centers. Fifty-six participants meeting inclusion criteria provided demographic and health information and were asked to read a public service brochure listing the five warning signs of stroke. Working memory was then assessed using the Wechsler Adult Intelligence Scale 3rd Edition Working Memory Index. Health literacy was assessed by the Short Test of Functional Health Literacy in Adults. Participants’ recall of the five warning signs of stroke was evaluated. The mean age was 80.4 years. The mean number of the signs of stroke recalled was 2.9 ± 1.33. Working memory and health literacy were positively correlated with recall of the signs of stroke (r = .38, p < 0.01; r = .44, p < 0.01). In a simultaneous regression, only health literacy remained a significant predictor of recall. There was no statistically significant interaction between working memory and health literacy. Findings from this study indicate that working memory and health literacy were associated with successful recall of the warning signs of stroke in older adults. Further studies are needed to determine if programs that include cognitive and literacy assessments could identify older adults who need additional support to learn and recall the signs of stroke.

Questions or comments about this article may be directed to Christine A. Ganzer, PhD RN, at She is an assistant professor at Hunter College, New York, NY.

Kathleen C. Insel, PhD RN, is an associate professor at University of Arizona, Tucson, AZ.

Leslie S. Ritter, PhD RN FAAN, is a professor at College of Nursing and Department of Neurology, William M. Feinberg Endowed Chair for Stroke Research, University of Arizona, Tucson, AZ.

The authors declare no conflicts of interest.

© 2012 American Association of Neuroscience Nurses