SAVVY LIBRARY SERVICES FOR SENIOR HEALTH

Michelle EberleConsumer Health Information CoordinatorNational Network of Libraries of Medicine New England Region

May 2009

http://nnlm.gov/ner/

What is the NLM?

National Library of Medicine Part of the National Institutes of Health The world’s largest biomedical library Creator of PubMed.gov, MedlinePlus.gov and

many other useful health information resources!!!

Agenda

Access and utilization of health information

Health information seeking behavior

Evaluation of health resources

Training and programs

Recommended resources

According to the CDC:

http://www.cdc.gov/aging/

Realities of health care today Patients are now asked to make major

decisions about their own disease process

Most patients do not have the tools to make these kinds of decision

You can provide your patrons with quality health information to enhance their coping skills, wellness and chronic disease management.

Health literacy

The ability to read, understand and act on health information [Pfizer 2002]

The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions [Healthy People 2010]

Why is health literacy so critical? Essential life skill

It is the bridge between knowledge and behavior.

Why is an understanding of health literacy important for older adults?

Adults age 63 and older have lower health literacy scores than all other age groups

Only 3% of older adults surveyed had proficient health literacy skills

The 2003 National Assessment of Adult Literacy

Ask Me 3

Essential questions to make sure your patient understands:

1. What is my main problem?2. What do I need to do?3. Why is it important for me to do this?

Source: Ask Me 3, Partnership for Clear Communication

Additional Factors

Vision and hearing changes 2 out of 3 adults with vision problem are over 65 Hearing loss – 1 in 3 adults over 60 and ½ over

85 Cognitive changes

Reduced processing speed More easily distracted Difficulty remembering

new information Disability

Additional Factors

Multiple conditions

Many, many medications

Talking to doctors

Internet comfort levels

Talking to Doctors: The New World Order Before 1972,doctors told patients what

they wanted patients to know, and what they wanted patients to do.

1972 – AHA Patient Bill of Rights “The patient has the right and is

encouraged to obtain from physicians and other direct caregivers relevant, current, and understandable information about his or her diagnosis, treatment, and prognosis.”

Talking to Doctors: The New World Order Now, doctors are just part of

the health care team – so is the patient!

The patient is now asked to make decisions about their own health care process

Where do patients get the tools to make those decisions?

Talking to Doctors: The New World Order

Ask Me 3™ http://www.askme3.org

Questions are the Answer http://www.ahrq.gov/questionsaretheanswer/

Older Adults and the Internet

Older Adults & the Internet

The Pew Internet & American Life Project http://www.pewinternet.org

Older Adults & the Internet

The number of older adults using the Internet increases as computer users join the ranks of older adults. “Seniors” are not just one generation.

Seniors who are online are as likely as younger users to go online on a typical day.

66% of seniors that use the Internet have looked for health information online.

Older Adults & the Internet

Most seniors live lives far removed from the Internet know few people who use email or surf the

Web cannot imagine why they would spend money

and time learning how to use a computer more likely than any other age group to be

living with some kind of disability which could hinder their capacity to get to a computer training center

Fox, Susannah. “Older Americans and the Internet.” Pew Internet & American Life Project. 25 March 2004.

Older Adults & the Internet

If 73% of adults over 65 are NOT using the Internet, how are they choosing among the 73 discount drug care programs online through the Medicare Web site?

To get email updates from CMS National Medicare Training Program: http://www.cms.hhs.gov/nationalmedicaretrainingprogram/EmailUpdates/List.asp

Health Seeking Behaviors

If not the Internet, where do older adults obtain health information? Health care providers Family Friends Workshops/Presentations Print resourcesPew Internet & American Life Project and

Health Information Seeking Behaviors of Older Adults: Results from an Interdisciplinary IMLS-funded Research Project, presentation at 2008 Medical Library Association by Mary Stansbury, Library and Information Science, University of Denver and Ruth Ludwick, College of Nursing, Kent State University.

Online Health Seeking Behaviors

Many older adults who use the Internet don’t know how to evaluate the information they find

Some either trust information found on the Internet too much or not at all

Wired seniors outpace younger Internet users on only one health topic: Medicare and MedicaidFox, Susannah. “Older Americans and the Internet.” Pew Internet & American Life Project. 25 March

2004.

What about Boomers?

In 10 years, boomers will age into the 65+ demographic

Younger baby boomers are most likely to have searched online for prescription drug information

Health seeking online is one of the only areas that boomers dominate over other generations

Evaluation of Health Resources

Not a real drug. Not a real disorder. A spoof.

Evaluation of Health Resources We’re going to skip the usual discussion

about health information evaluation: Accuracy Authority Bias Currency Coverage

And focus on special usability needs for older adults

Usability

Font size Glare-free background color/paper Clear organization “White” space Short sentences Jargon-free, definitions of medical terms

included Information in short segments Meaningful images

Usability

Additional Features for the Web Mouse-free controls Clear explanations No flashing images or distractions High contrast Step-by-step navigation “Read out loud” features highlighted text (hyperlinks) in color other

than blue

Click HERE to Win!!!!!

Library Programs

Program Planning

2008 IMLS-funded study in Ohio found that: There are two variables that have a

relationship to how likely it is that someone will read, watch, or use a particular resource:1. the health issue2. The particular resource

These are more important than who dispenses the information

Health Information Seeking Behaviors of Older Adults: Results from an Interdisciplinary IMLS-funded Research Project, presentation at

2008 Medical Library Association by Mary Stansbury, Library and Information Science, University of Denver and Ruth Ludwick, College of Nursing, Kent State

University.

Program Planning

Most preferred pamphlets/booklets People who were interviewed at senior

centers liked presentations or meetings People who were interviewed at libraries

generally preferred paper brochures and books to presentations or meetings

High blood pressure was the health topic of most importance to those interviewed

Health Information Seeking Behaviors of Older Adults: Results from an Interdisciplinary IMLS-funded Research Project, presentation at

2008 Medical Library Association by Mary Stansbury, Library and Information Science, University of Denver and Ruth Ludwick, College of Nursing, Kent State

University.

What programs for senior health information are offered by your library?What programs are you thinking about offering?

Sharing

Program Ideas

Wii! Exercise Relationships/dating Drug information Medicare Choosing nursing homes/assisted living Memory issues/keeping mind active Local resources Legal issues

Program Ideas

Caregiving End of Life planning Managing medications Evaluating health information

Health Fraud Advanced directives

Hospice Alternative medicines

Sexual Health

Teaching Health Information on the Internet

Why We Teach Health on the Internet to Older Adults

Bridge Digital Divide

Increase confidence

Increase knowledge of health conditions and healthy lifestyles

Help people know how to talk to doctors

Increase skills in evaluating health information resources

What are your tips for training seniors with online health information or online information in general?

Sharing

Teaching Tips

Observations from instructors: Seniors are very hungry for health information Seniors are eager to learn Learning a new technology may be anxiety

producing Lots of practice and repetition Transportation could be a problem Use health topics they are interested in (HBP) Provide regular access to computers Teach small groups, low teacher/student ratio

Teaching Resources

Beanworks: Computers, Older Adults, and Libraries http://beanworks.wordpress.com/

computers-older-adults-and-libraries/ Carol Bean, Palm Beach County Library Includes mousing tutorials Helpful articles Other training materials

Teaching Resources

NIHSeniorHealth: Helping Older Adults Search for Health Information Online:A Toolkit for Trainers http://nihseniorhealth.gov/toolkit/

toolkit.html

NIHSeniorHealth.gov toolkit for trainers

Lesson plans including:

Instructions for trainers

Handouts Practice Exercises

What’s new?

Highlights of NIH Senior Health Senior friendly format Short pages Ability to easily change text size, visual

contrast and add audio to the page Videos Share your exercise stories

Examples of information you can find on NIH Senior Health 30 senior specific health topics Balance problems Falls and older adults Sleep and aging Osteoporosis Exercise and older adults Stroke Taking medicines Hearing Glaucoma

NIHSeniorHealth.gov

Senior friendly online health information

Features:• Capability to increase

text size, turn on visual contrast, listen to page.

• Over 100 health videos

• Share your exercise stories

• Toolkit for trainers

User friendly features!

Senior Health Videos

Why NIH SeniorHealth.gov?

What if I need more in depth information?

MedlinePlus.gov

Created by the National Library of Medicine (NLM) which is part of the National Institutes of Health (NIH)

Funded with your tax dollars Provides health information for the

public

What will I find on MedlinePlus.gov?• Over 700 health topics• Drug information / herbal information• Medical encyclopedia• Medical dictionary• Directories• Local resources through “Go Local”• Health information in other languages• Surgery videos

What else will I find on MedlinePlus.gov? Health check tools Low Vision page Easy to read page The latest health news Email announcements and RSS feeds for

the latest health news The MedlinePlus Magazine

Home page here:

http://www.medlineplus.gov

MedlinePlus.gov also in Spanish!

In Spanish too! ¡En Español Tambíen! Just click on the yellow button to switch between English and Spanish!

Search alphabetically

Search with the Search

Box

Browse by body navigation maps

Navigating the health topics page…

100+ health topics for seniorsMedlinePlus.gov

Easy to read health information

Useful for creating handouts, flyers for seniors

Health Check Tools

For Seniors:• Joint Health Quiz (Arthritis Foundation)• Check your Arthritis Knowledge (American College of Orthopaedic Surgeons)• Test Your Back Health IQ (Amer. Acad. Of Physical Rehabilitation and Medicine)• Bladder Cancer Risk Questionairre (Siteman Cancer Center)• My Family Health Portrait (NIH)• Interactive Menu Planner (National Heart, Lung and Blood Institute)• Skin Cancer Risk: Understanding the Puzzle (National Cancer Institute)• My Pyramid.gov: Steps to a Healthier You (Department of Agriculture)• Glaucoma: How Much Do You Know (National Eye Institute)

What’s new?Visual Dx Health Pictures and Photographs

Search with body navigation maps

Body navigation maps

Different parts of the image are clickable, and show green highlighting when the user moves their mouse over the area

Menu on the right changes to related topics – in this case, The Bones

Drug, Supplement and Herbal Information

Drug information from AHFSAmerican Society of Health-System Pharmacists

Uses Based on Evidence

What is the most commonly used supplement according to the latest report by the National Center of Complementary and Alternative Medicine?

Question

Medical Encyclopedia & Dictionary

Encyclopedia includes over 4,000 entries on health topics, and an extensive library of illustrations.

Medical Dictionary

Directories Page

Doctors and Dentists

Hospitals and Clinics

Specialists

Other Healthcare Facilities & Services

Libraries

Directories for seniors: Doctor finders, Nursing Home Compare, Home Health Compare, and more!

The latest news from Reuter Health

What’s new? News now archived 90 days in English and Spanish.

Current Health News

News from Reuters and HealthDay

Searchable by date or topic

Email Announcements – very useful!

RSS feeds

Sign up for news from the link -Daily, weekly and specialty topics available

Can’t find your information on MedlinePlus?Here are alternative sources to consider…

Does your library provide health information for the public?

Have your library featured on the MedlinePlus.gov Library Directory!!!

Search Box Powered by Vivisimo

What are collections?

What are clusters?

Expert Search Tips for MedlinePlus.gov

Can I search for a Phrase?Yes, use quotation marks.

Example: “health services research”

Can I Restrict My Search to a Specific Website?Yes, you can restrict your search to a specific site by adding “site:” and the domain or URL to your search words.

Example: If you want to find breast cancer information in MedlinePlus onlyfrom the National Cancer Institute, search on:

“breast cancer site:cancer.gov.”

• http://www.nlm.nih.gov/medlineplus/searchtips.html

Expert Search Tips

Is the site case sensitive?

NO

Example: A search on “alzheimer’s disease” also retrieves pages containing the words, “Alzheimer’s Disease”

Will the site check my spelling?

YES

Is Boolean Searching Allowed?

Boolean searching

OR Use when you want either term, but not necessarily

both, to appear in the results

Example: Tylenol OR Acetaminophen

NOT or - Use when you do not want a particular term to appear in

the results /

Example: flu NOT bird or flu-bird

What about Wildcards?

+ Use when you want the word to appear in

your search results exactly as you typed it Example: +mammogram finds resources containing that exact

word; it does not find resources that contain the words mammography or mammoplasty

* Use as a wildcard when you want the search

engine to fill in the blank for you; you must enter at least three letters

Example: mammo* finds mammogram, mammography, etc

MedlinePlus Magazine

A quarterly publication of the Friends of the National Library of Medicine.

NNLM members get a free subscription for your library!

What’s new? …in Spanish too!

NIH MedlinePlus Salud MagazineBilingual format!

Multilingual health Information:In over 70 languages!

What’s new?A link to the Refugee Health Information Network added to the Multiple Languages Page!

Interactive tutorials get a new look!!!

Text Summary of Interactive Tutorials

MedlinePlus Go Local

http://medlineplus.gov/golocal

Search by: Location, Provider or Disease

Search Go Local on MedlinePlus:

Home page Health topics Or directly on the

state’s Go Local site

Example of search in Go Local Massachusetts for Complementary and Alternative Care Providers for Cancer in Suffolk County

Get HTML code to link directly to a MedlinePlus icon for the homepage or add a MedlinePlus Search Box to your site.

Do not link to any of the licenses materials on MedlinePlus: surgery videos, Patient Education tutorial, news stories, or encyclopedia

Includes some tutorials you may download and use when there is no access to the Internet.

Surgery Videos

Source: OR-Live.com

The most popular surgery video?

Surgery videos

For older adults: Hip replacement Hiatal Hernia Cancer Surgeries Osteoporosis And about 100

others!

In Review: Why MedlinePlus?

MedlinePlus http://medlineplus.gov Links to reliable, understandable

health websites Health Topics for Seniors Easy-to-read articles Slideshows that have sound and contrast Medical dictionary Medical encyclopedia with large illustrations Links to local services English, Spanish and other languages No Advertisements!

What other resources are useful for senior health information?

Sharing

Recommended Resources

National Institute on Aging http://www.nia.nih.gov Free publications (English and Spanish) Azheimer’s Disease Education and Referral

Center (ADEAR) Database of more than 300

national organizations that provide help to older adults.

Recommended Resources

http://positiveaging.org/

Books

The Merck Manual of Medical Information: Home Edition http://www.merck.com/mmhe/index.html

The Merck Manual of Health & Aging http://www.merck.com/pubs/mmanual_ha/

contents.html

Collection development guidehttp://library.uchc.edu/departm/hnet/agingresource.htmlUCONN Healthnet: Growing Older: A Health Related Resource Guide

Other core lists

CAPHIS Collection Development Lists http://caphis.mlanet.org http://caphis.mlanet.org/resources/

index.html#coldev

UCONN Healthnet Resource guides for consumers and librarians http://library.uchc.edu/departm/hnet/

Toronto Public Library http://www.torontopubliclibrary.ca/uni_chi_core.jsp

Take home points

Older adults are hungry for health information.

Librarians are uniquely qualified to bridge the digital divide for older adults.

We are knowledgeable about technology and information resources.

Think about the resources learned today. Who can you help by sharing this

information?

Questions?

Thank You!

Michelle Eberle, MSLISConsumer Health Information CoordinatorNational Network of Libraries of Medicine

New England Region800-338-7657

michelle.eberle@umassmed.edu

Presentation co-authored by Karen Vargas