Relationship between attitudes toward aging and health literacy among Taiwanese older men

Background: Men’s health issues often receive less attention in public health discussions than women’s health. This study examines how older men’s demographic characteristics influence their attitudes toward aging and health literacy. Methods: A cross-sectional study assessed 157 older men (mean age = 75.57, SD = 7.10) from Tier-C stations. Participants completed the Health Literacy Questionnaire for Older Adults (HLQ-QA) and the Taiwan Attitude Toward Aging Questionnaire. T-tests compared aging perceptions and health literacy abilities, while regression analyses assessed the influence of attitudes on health literacy. Results: Mean positive and negative aging perception scores were 31.45 (SD = 4.18) and 18.23 (SD = 4.45), respectively. The average HLQ-QA score was 47.84 (SD = 6.59), with competency scores ranked as: appraising (M = 12.12, SD = 1.73), understanding (M = 12.03, SD = 1.91), accessing (M = 11.90, SD = 1.84), and applying (M = 11.80, SD = 2.04). Regression analyses showed that positive perceptions significantly improved health literacy (β = 0.197, p = 0.013), while negative perceptions reduced it (β = −0.227, p = 0.005). Conclusions: Positive attitudes toward aging enhance older men’s health literacy, whereas negative perceptions hinder their ability to process health information. Community programs should focus on men with lower education levels, those living alone, and those without Internet access. Promoting positive attitudes and combating ageism are critical for improving health literacy and achieving healthy aging.

Ageism; Attitude; Aging; Health literacy; Older men

[1] Hossin M. The male disadvantage in life expectancy: can we close the gender gap? International Health. 2021; 13: 482–484.

[2] World Health Organization. World Health Statistics 2024: monitoring health for the SDGs, sustainable development goals. 2024. Available at: https://www.who.int/data/gho/publications/world-health-statistics (Accessed: 23 May 2024).

[3] Ministry of Health and Welfare. Report of the Senior Citizen Condition Survey 2022. 2023. Available at: https://www.mohw.gov.tw/dl-87307-f5227573-4ceb-42b3-9325-f5a57b4981f6.html (Accessed: 23 May 2024).

[4] Department of Statistics, Ministry of the Interior, Republic of China. Abridged life table of republic of China, 2022. 2023. Available at: https://ws.moi.gov.tw/Download.ashx?u=LzAwMS9VcGxvYWQvNDAwL3JlbGZpbGUvMC8xOTA0My80ZjZlYjdmNS0wMGE1LTQyNzctOTgyNC0xYmNmNDA0MmU3OGQucGRm&n=MTEx5bm057Ch5piT55Sf5ZG96KGo6Zu75a2Q5pu4LnBkZg%3d%3d&icon=.pdf (Accessed: 25 May 2024).

[5] World Health Organization. Shanghai declaration on promoting health in the 2030 agenda for sustainable development. 2016. Available at: https://apps.who.int/iris/rest/bitstreams/1090104/retrieve (Accessed: 30 May 2024).

[6] Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012; 12: 80.

[7] de Wit L, Fenenga C, Giammarchi C, di Furia L, Hutter I, de Winter A, et al. Community-based initiatives improving critical health literacy: a systematic review and meta-synthesis of qualitative evidence. BMC Public Health. 2017; 18: 40.

[8] Wolf MS, Gazmararian JA, Baker DW. Health literacy and functional health status among older adults. Archives of Internal Medicine. 2005; 165: 1946–1952.

[9] Chesser AK, Keene Woods N, Smothers K, Rogers N. Health literacy and older adults: a systematic review. Gerontology and Geriatric Medicine. 2016; 2: 2333721416630492.

[10] Lin CW, Ho CJ, Huang RY, Wang WD. Health literacy: conceptual development and practical application. Taiwan Journal of Family Medicine. 2016; 26: 65–76.

[11] Liu J, Wei W, Peng Q, Guo Y. How does perceived health status affect depression in older adults? Roles of attitude toward aging and social support. Clinical Gerontologist. 2021; 44: 169–180.

[12] Fernández-Jiménez C, Dumitrache CG, Rubio L, Ruiz-Montero PJ. Self-perceptions of ageing and perceived health status: the mediating role of cognitive functioning and physical activity. Ageing & Society. 2024; 44: 622–641.

[13] Levy BR, Slade MD, Kasl SV. Longitudinal benefit of positive self-perceptions of aging on functional health. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences. 2002; 57: P409–P417.

[14] Lawton MP. The Philadelphia geriatric center morale scale: a revision. Journal of Gerontology. 1975; 30: 85–89.

[15] Kite M, Stockdale G, Jr B, Johnson B. Attitudes toward younger and older adults: an updated meta-analytic review. Journal of Social Issues. 2005; 61: 241–266.

[16] Gale CR, Cooper C. Attitudes to ageing and change in frailty status: the English longitudinal study of ageing. Gerontology. 2018; 64: 58–66.

[17] Bedaso TS, Han B. Attitude toward aging mediates the relationship between personality and mental health in older adults. Healthcare. 2021; 9: 594.

[18] Levy BR, Ferrucci L, Zonderman AB, Slade MD, Troncoso J, Resnick SM. A culture-brain link: negative age stereotypes predict Alzheimer’s-disease biomarkers. Psychology and Aging. 2016; 31: 82–88.

[19] Siebert JS, Wahl HW, Degen C, Schröder J. Attitude toward own aging as a risk factor for cognitive disorder in old age: 12-year evidence from the ILSE study. Psychology and Aging. 2018; 33: 461–472.

[20] Wu CH, Chen CY, Hsu CC, Wu YC. Development and psychometric properties of the Taiwan attitude toward aging questionnaire (TAAQ). Chinese Journal of Mental Health. 2016; 29: 159–186. (In Chinese)

[21] Luo YX, Liu CC, Wang YL. Older adults’ motivation for social contact of learning and active aging: the mediating effect of attitudes toward aging. Journal of Research in Education Sciences. 2022; 67: 177–204.

[22] Jang Y, Poon LW, Kim SY, Shin BK. Self-perception of aging and health among older adults in Korea. Journal of Aging Studies. 2004; 18: 485–496.

[23] Liu HC. A preliminary exploration of the impact of core self-evaluation on aging attitudes among the elderly. Counseling and Guidance. 2023; 10–13+23+30+45. (In Chinese)

[24] Kuo SH, Liang MH. Development and validation of the health literacy scale for community-dwelling older adults in Taiwan. Health Promotion International. 2023; 38: daad112.

[25] Lee CJ, Ho MH, Joo JY, Montayre J, Lin YK, Chang CC, et al. Gender differences in the association between oral health literacy and oral health-related quality of life in older adults. BMC Oral Health. 2022; 22: 205.

[26] Serper M, Patzer RE, Curtis LM, Smith SG, O’Conor R, Baker DW, et al. Health literacy, cognitive ability, and functional health status among older adults. Health Services Research. 2014; 49: 1249–1267.

[27] Liu YB, Liu L, Li YF, Chen YL. Relationship between health literacy, health-related behaviors and health status: a survey of elderly Chinese. International Journal of Environmental Research and Public Health. 2015; 12: 9714–9725.

[28] Agarwal G, Habing K, Pirrie M, Angeles R, Marzanek F, Parascandalo J. Assessing health literacy among older adults living in subsidized housing: a cross-sectional study. Canadian Journal of Public Health. 2018; 109: 401–409.

[29] Protheroe J, Whittle R, Bartlam B, Estacio EV, Clark L, Kurth J. Health literacy, associated lifestyle and demographic factors in adult population of an English city: a cross-sectional survey. Health Expectations. 2017; 20: 112–119.

[30] Lin CC, Kuo CT, Tsai MR. Association of functional, interactive, and critical health literacy with good self-rated health among Taiwanese community-dwelling older adults. Geriatric Nursing. 2022; 43: 91–96.

[31] Meppelink C, Smit E, Diviani N, Weert J. Health literacy and online health information processing: unraveling the underlying mechanisms. Journal of Health Communication. 2016; 21: 109–120.

[32] Kirwan L, Lambe B, Carroll P. An investigation into the partnership process of community based health promotion for men. International Journal of Health Promotion and Education. 2013; 51: 108–120.

[33] Nutbeam D, Lloyd JE. Understanding and responding to health literacy as a social determinant of health. Annual Review of Public Health. 2021; 42: 159–173.

[34] Iwasa H, Yoshida Y. Personality and health literacy among community-dwelling older adults living in Japan. Psychogeriatrics. 2020; 20: 824–832.

[35] Levy B. Stereotype embodiment: a psychosocial approach to aging. Current Directions in Psychological Science. 2009; 18: 332–336.

[36] Lytle A, Apriceno M, Dyar C, Levy SR. Sexual orientation and gender differences in aging perceptions and concerns among older adults. Innovation in Aging. 2018; 2: igy036.

[37] Zorrilla-Muñoz V, Agulló-Tomás MS, Rodríguez-Blázquez C, Ayala A, Fernandez-Mayoralas G, Forjaz MJ. Ageing perception as a key predictor of self-rated health by rural older people—a study with gender and inclusive perspectives. Land. 2022; 11: 323.

[38] Men’s Health Forum. How to make mental health service work for men. 2015. Available at: https://www.menshealthforum.org.uk/sites/default/files/pdf/how_to_mh_v4.1_lrweb_0.pdf (Accessed: 25 May 2024).

[39] Hsu CC, Yang SY, Lee YC, Chien HW. Relationship between aging attitude and mental health among elderly. Journal of Taiwan Occupational Therapy Research and Practice. 2021; 17: 53–61. (In Chinese)

[40] Ormsby J, Stanley M, Jaworski K. Older men’s participation in community-based men’s sheds programmes. Health & Social Care in the Community. 2010; 18: 607–613.

[41] Milner A, Kavanagh A, King T, Currier D. The influence of masculine norms and occupational factors on mental health: evidence from the baseline of the Australian longitudinal study on male health. American Journal of Men’s Health. 2018; 12: 696–705.

[42] Lu L, Chen HH. An exploratory study on role adjustment and intergenerational relationships among the elderly in the changing Taiwan. Research in Applied Psychology. 2002; 221–249. (In Chinese)

[43] Blawert A, Schäfer SK, Wurm S. Associations of agency and communion with domain-specific self-perceptions of aging: a cross-sectional study in old-old adults in poor health. International Journal of Aging and Human Development. 2022; 95: 245–262.

[44] Korkmaz Aslan G, Kartal A, Özen Çınar İ, Koştu N. The relationship between attitudes toward aging and health-promoting behaviours in older adults. International Journal of Nursing Practice. 2017; 23: e12594

[45] Cai Y, Ren X, Wang J, Hou Y, Zhang M, Chen O. Associations between self-perceptions of aging and social functioning in older adults: an analysis based on health and retirement study data. Archives of Gerontology and Geriatrics. 2024; 119: 105307.

[46] Hori S, Cusack S. Third-age education in Canada and Japan: attitudes toward aging and participation in learning. Educational Gerontology. 2006; 32: 463–481.

[47] Gu D, Dupre ME, Qiu L. Self-perception of uselessness and mortality among older adults in China. Archives of Gerontology and Geriatrics. 2017; 68: 186–194.