The Digital Health Divide: Technology Alone Won't Get Older Adults Connected

Digital health tools promise to help older adults manage their health, connect with clinicians, and live independently at home, and digitisation will be a cornerstone of the NHS transformation reforms over the next decade. For many, this transformation might be driving more of our older members of society to feel increasingly excluded from their health service.

Consider an 82-year-old trying to navigate a patient portal, trying to log into their ageing laptop which now takes more than 10 minutes to boot up, then caught in an endless cycle of password resets and once they achieve access are overwhelmed by medical jargon they don't understand. This is the reality for many older adults.

And this is the ones that do have internet access. And many dont.

In the UK, 29% of people aged 75 and over remain non-internet users (Age UK, 2024). Furthermore, across the EU, fewer than 40% of those aged 65–74 have basic digital skills (Eurostat, 2024). Behind these averages lie even sharper gradients of inequality, we know that exclusion increases with poverty, isolation, disability, and across different cultures and language barriers.

Digital health literacy, having the skills and ability to use digital devices and locate, interpret, and act on health information, cannot be assumed. The cognitive effort required to learn new digital systems while managing multiple chronic conditions can be overwhelming. Even if they are willing to try, many find the process alien and unsafe. Confidence erodes quickly when the digital systems and language is overwhelmingly complex and there is no one around to help and explain.

Older adults generally prefer tools that feel familiar, predictable, and integrated into everyday life. Learning to manage complex interfaces competes with the cognitive and emotional labour of managing health itself. This isn't resistance to innovation; it's pragmatism.

As we digitise our health services we have a moral obligation to ask not just "can older people use digital health technologies?" but also "what conditions will make digital health usable for older people?"

Design that succeeds, starts from deep understanding of users' lived contexts and experience; the environments, habits, and relationships that shape daily use. Simplicity is equally vital. A medication reminder that needs daily manual input will fail; one that learns patterns and adapts quietly will succeed. Co-design approaches have shown the most promise at drawing such nuances out during the design phase, because they inform assumptions through dialogue. When older adults and carers are part of the design process, the resulting tools tend to be more intuitive, humane, and relevant, and ultimately used.

Trust, a significant adoption barrier, is built through transparent communication, consistent experience, and designs that make life simpler rather than adding new burdens.

Privacy and security anxieties among older adults are rarely about ignorance and more often about fear. People want to know how their data will be used and whether it will be used in their best interests. Digital systems that explain clearly, in plain language, why data is collected and how it benefits them, are far more likely to be accepted.

Above all, technology should strengthen rather than substitute human contact. Remote monitoring, as an example, can extend care in between consultation and provide reassurance, enabling better communication and follow-up, but when it becomes the only form of human connection, it can erode trust and increase loneliness.

Technology is taken up socially, not in isolation. What enables adoption are relationships, the "relational scaffolding" that slowly builds confidence. Whether or not someone can use a technology will be influenced by whether someone has been shown patiently, whether their GP has encouraged them to try and use it.

Peer learning follows the same logic. The Older Adults Technology Services (OATS) model in the US, trains older volunteers to teach their peers digital skills and how to use technology to improve their lives and communities. It focuses on three main areas: technology education, digital inclusion, and creating age-friendly environments. Their flagship program, Senior Planet, provides in-person and online classes, programs, and centres for older adults to learn and engage with technology.

Underpinning this approach is the understanding of the need to build familiarity over time through shared experiences. Technology use becomes a social practice rather than a test of skill.

In the NHS, the emergence of health technology navigators has a growing evidence base of successes. Community-based workers offer hands-on support to older adults, supporting adoption. Short, one-off "digital literacy" sessions rarely last; what works is steady, trusted guidance over time. Local digital health hubs, held within local communities, often in libraries or voluntary sector settings, give people a space to learn informally, with peers and support workers nearby. A reminder that digital inclusion requires social infrastructure.

The SUS-IT programme, led by Loughborough and Nottingham universities, reached a similar conclusion over a decade ago. It found that older adults retained digital confidence not through one-off training but through ongoing companionship. Peer-led "computer clubs" which turned learning into a social routine, which slowly built and sustained confidence even after the formal classes ended.

The same logic underpins successful digital health interventions today: continuity, trust, and simplicity are the real drivers of sustained use.

There is increased use of voice-based systems such as FitChat. Most digital behaviour-change tools for older adults rely on static text prompts. FitChat takes a different approach. Using advances in conversational AI, it interacts through natural dialogue, allowing users to respond in their own words. This shift turns a digital nudge into something more human and simpler to navigate for older adults.

Passive sensor systems like MAISON are also being used in a way that bypasses user interaction all together. It gathers wellbeing data unobtrusively, using familiar smart-home sensors to gather information passively, such as movement, temperature, sleep, and daily patterns, reducing cognitive load on the older adult. These technologies work precisely because they don't demand constant interaction; they account for the limits of attention, dexterity, and energy in older adults, working with not against these factors.

What older adults need is more agency: what that means is for an understanding that technology can be used enable them to stay connected with their families, remain independent, and seen in many different areas of their lives.

Agency depends on design choices that respects choice. For older adults, digital inclusion will not come from teaching more people to use the system as it stands. It will depends on creating health systems that encourages and supports and doesn't penalise people for preferring face to face care. And it will depend on whether we have clinicians who can provide reassurance and continuity along care pathways, however a person wishes to access care. Importantly, it will come from redesigning the system so that it recognises, respects, and adapts to the diversity of how people live, age, and connect.

If we measure progress only by uptake, we will keep mistaking participation for inclusion. Older adults are not a hard-to-reach group. The real measure is whether digital health makes all of our older population feel more confident in the health system that serves them. They are the measure of whether our digital health systems are ready for everyone. When technology works for them, when it is trusted, usable, and intuitive, it will work better for all of us.

The EquiIndex Digital Health Equity Maturity Framework is a structured self-assessment tool that helps health and care providers understand how far their digital transformation efforts are advancing equity, and where the gaps remain. It's a practical way to turn ambition into action.

• Age UK (2024). Digital Inclusion Evidence Review. https://www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/reports-and-briefings/active-communities/rb-apr24_digital-inclusion-evidence-review.pdf
• Eurostat (2024). Individuals' Level of Digital Skills. https://ec.europa.eu/eurostat/databrowser/view/isoc_sk_dskl_i/default/table?lang=en
• NHS England (2024). Inclusive Digital Healthcare Framework. https://www.england.nhs.uk/digitaltechnology/digital-inclusion/inclusive-digital-healthcare/
• SUS-IT Project (2012). Sustaining IT Use by Older People – Final Report. Loughborough & Nottingham Universities. https://repository.lboro.ac.uk/articles/report/SUS-IT_Sustaining_IT_use_by_older_people_-_final_report/9590864
• Older Adults Technology Services (OATS). Senior Planet Programme. https://seniorplanet.org/about-us/
• FitChat Study (2024). Delivery of Conversational AI Behaviour Change Interventions for Physical Activity. JMIR mHealth and uHealth. https://mhealth.jmir.org/2024/3/e54892
• MAISON Platform (2023). Multimodal Sensor System for Older Adults Living Independently. Sensors Journal, MDPI. https://www.mdpi.com/1424-8220/23/2/812