A third of middle-aged adults struggle with basic health tasks

Clinical takeaway: Verify comprehension rather than assume it, particularly with a new diagnosis. Simplify patient materials to a 6th to 8th grade reading level and ask not just whether patients are taking medications, but how. Broader health literacy guidelines also support using teach-back methods and plain language tools.

Health literacy problems have long been documented in older adults, but a new study suggests the gaps are just as relevant in the midlife window when chronic conditions often first appear and self-management skills start to matter more.

Nearly one in three middle-aged adults, or 32.5%, had limited health literacy in a study of 1,000 adults ages 35 to 64. Participants struggled with hands-on tasks including reading prescription labels, recalling details after a simulated diagnosis visit, and interpreting written care materials.

Lower health literacy was associated with lower income, less education, and unemployment, and those with poorer skills had more chronic conditions, were prescribed more medications, and performed worse on cognitive testing.

Researchers recruited adults receiving care at Northwestern-affiliated hospitals and federally qualified health centers in Chicago. Participants had to have had at least one doctor visit in the past year or one scheduled in the next six months. Health literacy, self-management, and physical function were assessed through interviews and hands-on tasks.

The findings challenge the assumption that health literacy problems are primarily a concern for older adults. Midlife is when chronic conditions such as hypertension, high cholesterol, and diabetes typically emerge, making it a critical window for intervention. The authors note that patient materials are currently written at a high school or college level, well above what a third of middle-aged patients can reliably navigate.

"We didn't think the problem was going to be this pervasive, but to think that people are reaching their mid to late 30s and 40s, and they haven't been onboarded properly to perform basic personal health tasks is pretty powerful," said corresponding lead author Abigail Vogeley, a neuropsychology doctoral student at Northwestern University Feinberg School of Medicine.

Source: Vogeley et al. J Gen Intern Med. June 10, 2026. Prevalence of Limited Health Literacy During Middle Adulthood and Its Associations with Health Self-Management and Physical Function