DOI: 10.1002/alz.071279 ISSN: 1552-5260

Association Between Internet Accessibility and Health Literacy among Community‐Dwelling Older Adults with Cognitive Frailty (CF) from Lower Socioeconomic Status (LES) group: A Cross‐sectional Study

Nurul Hidayah MD Fadzil
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Geriatrics and Gerontology
  • Neurology (clinical)
  • Developmental Neuroscience
  • Health Policy
  • Epidemiology



The objective of this study was to determine the association between internet accessibility, health literacy and sociodemographic factors among older adults with cognitive frailty (CF) from lower socioeconomic status (LES) group.


This study was a part of the AGELESS trial’s screening phase, which was conducted from October 2021 till March 2022 for developing telehealth multi‐domain intervention. The data included were sociodemographic variables, internet access and health literacy index. About 282 community‐dwelling older people aged 60 years (mean age 68.65 ± 6.52) from lower socioeconomic status (LES) participated in this study. Purposive sampling was utilized to identify cognitive frailty using Fried’s Criteria and Clinical Dementia Rating (CDR) while health literacy was measured using Health Literacy Questionnaire HLS‐M‐18 (Health Literacy Index). Linear regression was performed to analyse the sociodemographic factors influencing health literacy.


In this study, we found that more participants who accessed to Internet compared to Internet non‐users, 68.1% and 31.9%, respectively. They significantly consisted of females (54.1%), married (56.8%), obtained secondary education level (61.1%) and still working (69.7%) (p<0.05). The majority of them (75.1%) utilised digital technology devices in their daily life for example smartphones (70%), computers or laptops (4.4%), followed by tablets (3.7%) which their primary functions were for family interaction and update online news, 67.8% and 31.3% respectively. In addition, Internet users among older adults with cognitive frailty from the LES group had a 3‐fold better health literacy than internet non‐users (OR 3.248, 95% CI: 1.059 – 5.436, p<0.05). Those who were married and higher education level were also the main factors influencing their health literacy in this target population (OR 2.314, 95% CI: 0.241 – 4.386, p<0.05; OR 0.494, 95% CI: 0.219 – 0.768, p<0.05).


Our findings imply that Internet users among older people with CF from the LES group adopted the Internet mainly for family connection and update online news. Future research should emphasize the understanding of Internet adoption as a non‐pharmalogical intervention for cognitive frailty such as telehealth or mobile health (mHealth) using specific mechanisms for instance qualitative or mixed method design.

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