Association between health literacy and awareness of the term ‘frailty’ among community-dwelling older adults in Japan

PURPOSE: Although the Japan Geriatrics Society proposed fureiru as the term for frailty, public awareness remains low. Health literacy, defined as the ability to access and use health information, may influence frailty awareness; this association remains unelucidated. We investigated the association between health literacy and frailty awareness among community-dwelling older adults in Japan. METHODS: This cross-sectional study used data from a mail survey conducted in 2024 among functionally independent adults aged ≥65 years in Habikino City, Japan. Frailty awareness was assessed by asking "Do you know the term fureiru?", with two definitions: awareness of the term (having heard the term or knowing its meaning) and self-perceived understanding of its meaning (knowing its meaning only). Health literacy was measured using the Communicative and Critical Health Literacy Scale. Adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) were estimated using modified Poisson regression models controlling for demographic and health-related covariates. RESULTS: Among 6,006 participants, awareness of the term "frailty" was 58.3%, while self-perceived understanding of its meaning was 34.6%. Compared with the lowest health literacy quartile (Q1), adjusted PRs (95% CIs) for frailty awareness were progressively higher across quartiles [awareness of the term: 1.25 (1.16, 1.34), 1.32 (1.23, 1.41) and 1.40 (1.30, 1.51); self-perceived understanding of its meaning: 1.49 (1.30, 1.69), 1.81 (1.60, 2.05), and 2.23 (1.96, 2.53)]. CONCLUSION: Higher health literacy was significantly associated with greater frailty awareness. Future longitudinal and interventional studies should determine whether public health initiatives targeting health literacy can improve frailty awareness and contribute to frailty prevention.