Measuring health literacy in older people: a scoping review

Objective: To collect and compare studies that measured health literacy (HL) in older adults. Study design: Scoping Review. Methods: A literature search in PubMed, Embase, Scopus and Web of Science, was conducted in 2023, including studies published in English and Italian. Inclusion criteria involved primary studies that provided a quantitative HL measurement in people aged 60 years and more. Articles examining people recruited from hospitals or emergency rooms and those selecting participants with specific diseases, except for newly diagnosed patients, were excluded. Results: Our literature search yielded a total of 6374 records, with 158 articles meeting the inclusion criteria. The most frequently used tools were the S-TOFHLA, HLS-EU-Q16, NVS, HLS-EU-Q47, Communicative and Critical Health Literacy Scale, TOFHLA and REALM. Some differences emerged, even among studies using the same tool. These differences may be due to variations in reporting results (e.g., means, cutoffs, or other formats) or discrepancies in scoring scales, which may have different ranges or apply cutoff scores differently. Conclusions: Our results identified a wide range of tools used, with considerable variation even when the same instrument was employed, particularly in scoring methods and the definition of cutoffs to distinguish HL levels. Many papers were excluded because age-specific data for older adults were not extractable, therefore reporting results by age group should be encouraged.