Understanding the role of financial health literacy in midlife and old age: A scoping review

Abstract

As global population ageing persists, understanding older adults' capacity to navigate the financial and healthcare system is essential. This scoping review examines how the concept of financial health literacy (FHL) is described and measured in the existing literature, the factors that may affect it, and its potential outcomes in middle‐aged and older adults. The review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analysis) extension guidelines to synthesise the available evidence on this topic. We utilised electronic databases and hand searching to identify relevant literature published between 2010 and 2022. A total of 29 articles were included in this review. The results showed that FHL involved accessing, understanding and utilising financial information for planning/management of healthcare expenses and selecting appropriate health services. However, FHL is not particularly depicted as a concept in the current literature, as most studies investigated health literacy, financial literacy and health insurance literacy as separate domains that were interrelated to one another. No validated measurement tool was developed for FHL. We propose five domains to indicate the concept and measurement of FHL in middle‐aged/older adults: money management, management of medical bills, understanding health insurance, deciding on appropriate health services, and planning for long‐term care needs. Demographic variables, such as sex (females), advanced age, cognitive impairment, low education and income and racial and ethnic minorities, were found to be related to low FHL. The reviewed studies also showed that FHL was related to several outcomes, including healthcare decision‐making, physical health and psychological well‐being. Hence, future studies to develop and validate assessment tools of FHL, together with the involvement of vulnerable groups, are imperative to understanding the concept of FHL. This could also facilitate the development of appropriate interventions that could enhance this capacity in the ageing population.

Financial Health Literacy and Community-Dwelling Older Adults: A Concept Analysis

“…Comprehension must extend to knowledge of what the current and future needs are, including the capacity to understand fnancial and healthrelated choices [8]. Older adults must understand costs related to healthcare, insurance, self-management, and daily living [3].…”

“…Using fnancial resources wisely to make healthcare-related decisions will positively infuence both health insurance choices and the use of the healthcare system, for example, by maximizing choosing and using health insurance aptly by shopping around for healthcare [22]. Financial behaviors include making sound healthcarerelated fnancial decisions (i.e., having an adequate amount of money saved up for healthcare expenses that will be incurred after retirement); managing money (i.e., monthly premiums, copays, and covering unpredictable healthcare costs); and ensuring living expenses are paid for (i.e., creating a budget on a fxed income) [3,8]. Financial knowledge is used to make short-term and long-term healthcare decisions related to budgeting and saving within the context of health, and research suggests that there is a relationship between using health information and fnancial knowledge to make informed healthcare decisions [3,4,8,22].…”

“…Te potential beneft of FHL on health outcomes and successful aging [3] is evident in the research literature. For example, research suggests that older adults with higher FL and HL had better diabetes indicators and improved knowledge specifc to the disease [43] and a decreased risk of hospitalization [46].…”

“…Both HL and FL are vital to the success and quality of life of individuals; however, fnancial health literacy (FHL) is a relatively new concept and there is very little literature that addresses this important synthesis. Research eforts are hindered by a lack of a common defnition for FHL, and there is a need for theoretical work to establish the concept of FHL [3]. FHL is particularly important for older adults (≥65 years old) due to complexities related to aging.…”

“…Notably, many of the social factors that impact health also impact literacy levels. Research suggests that individuals who lack English language skills, immigrants [6], and racial and ethnic minorities are at higher risk for low literacy levels [3,7]. Additionally, factors that put individuals at increased risk for low fnancial or HL include having low educational attainment, advanced age, and being female [3,6,[8][9][10].…”