Baby boomers, Millennials, and Gen
A new study from Northwestern University found that one in three middle-aged American adults between the ages of 35 and 64 cannot consistently read prescription instructions correctly, understand medical forms, or recall details of doctor visits involved in diagnosing chronic conditions. These skills – also known as health literacy – are important for managing common conditions such as high blood pressure, high cholesterol and diabetes that commonly develop in midlife.
I never expected this problem to become so prevalent, but it’s shocking to think that people are in their mid-to-late 30s and into their 40s and still aren’t getting basic personal health care right. This study is not about pointing out what people can’t do, but rather, can we reduce patient confusion?”
Abigail Vaugerie Corresponding first author, Researcher and neuropsychology doctoral student in the Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine
Previous studies have found that more than half of adults over 65 experience difficulty participating in the health care system, but this is the first study to focus on middle-aged adults.
This study was published on June 10th. General Internal Medicine Journal.
“There is no clear ‘user manual’ for approaching health care in midlife,” said Michael Wolff, director of the center and senior author of the Feinberg School of Medicine. “Our findings suggest that people are not adequately prepared to participate in and manage their care.”
Sample size is 1,000 participants
The study included 1,000 adults treated at Northwestern-affiliated hospitals and federally qualified health centers throughout Chicago. To be eligible for the study, participants had to have seen a doctor at least once in the past year or had a doctor’s appointment scheduled in the next six months.
Participants completed interviews and hands-on tasks such as interpreting prescription labels (e.g., should I take it with food? Can I drink alcohol or be exposed to the sun while taking it?), remembering a doctor’s orders after watching a clinical video of a diagnosis of gastroesophageal reflux disease, reviewing written care materials, and other typical health tasks.
“Doctors may ask patients, ‘Are you taking your medication?’ But we don’t ask how they’re taking it, so people may think, ‘I’m doing well, I’m taking my medication,’ but they don’t realize they’re making a mistake,” Wolf said.
Breakdown of survey results
Researchers used a variety of screening tools to assess health literacy, health self-management, and self-reported physical function.
They discovered:
- 32.5% had limited health literacy skills
- Lower health literacy was associated with lower income, lower education, and unemployment.
- People with lower skills had more chronic illnesses, were prescribed more medications, and performed worse on cognitive tests.
“Patients differ not only by demographics but also by their ability to manage their care,” Vaugerie says.
Currently, many patient materials are developed at the high school or college level. The authors recommend simplifying health information using plain language at the 6th to 8th grade level.
They also highlight broader implications for health systems.
“Billions of dollars are spent developing drugs, but far less is invested in ensuring patients use them correctly,” Wolf said. “A better understanding could significantly improve outcomes and reduce harm.”
Chronic diseases in midlife
Extensive research has found that approximately two-thirds of U.S. adults between the ages of 45 and 64 are managing at least one chronic disease, and one-third are managing multiple chronic conditions.
“We automatically assume that people in middle age will know what they’re doing when it comes to their health, but this is the time when chronic diseases start to appear, and diagnosis is often delayed because of variations in how patients access health care,” Wolf says.
If patients are unable to properly manage their chronic conditions, they may require hospitalization and worsen their health, Wolf said.
“The focus has always been on older adults. Cognitive decline may lead to medication misuse, but our findings suggest that health literacy is suboptimal, even in middle age,” Vaugerie said. “As middle-aged people become older adults, there may be room for intervention if we are optimistic.”
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Reference magazines:
Vaugerie, A. others. (2026). The prevalence of limited health literacy in middle adulthood and its association with health self-management and physical functioning. General Internal Medicine Journal. DOI: 10.1007/s11606-026-10560-x. https://link.springer.com/article/10.1007/s11606-026-10560-x
