Introduction
Older adults play an important role in the economic growth of a country. Empirical evidence shows that life expectancy gradually increases (Beltrán-Sánchez et al., Reference Beltrán-Sánchez, Soneji and Crimmins2015). In 2018, the proportion of older adults aged 65 and above was 17.2 per cent, which is expected to rise to 21.4%–25.9% in 2043 in Canada (Smale et al., Reference Smale, Wilson and Akubueze2022). It is crucial to ensure a healthy aging population so that older adults can contribute to the welfare of society and the economic growth of a country. However, over one-third of older adults have two or more chronic health conditions and other health risks, and this trend creates pressure on the economy (Prince et al., Reference Prince, Wu, Guo, Robledo, O’Donnell, Sullivan and Yusuf2015; Tam, Reference Tam2020).
COVID-19 has had a severe impact on the health care system and contributed to poorer health among older adults. The pandemic also resulted in poor lifestyle modifications such as sleep disturbance, unhealthy food intake, and alcohol use for older adults (Lebrasseur et al., Reference Lebrasseur, Fortin-Bédard, Lettre, Raymond, Bussières, Lapierre, Faieta, Vincent, Duchesne, Ouellet, Gagnon, Tourigny, Lamontagne and Routhier2021). The pandemic introduced digital health as a feasible support for the general population. Older adults may benefit if they have difficulty accessing transportation or if they are caring for family members. Furthermore, digital health can help to address the increased workload in hospitals. A prospective cohort study in the Canadian Longitudinal Study on Aging showed that older adults experienced less difficulty accessing healthcare services or visiting a doctor due to digital health, such as virtual visits (Bhatia et al., Reference Bhatia, Chu, Pang, Tadrous, Stamenova and Cram2021; Glazier et al., Reference Glazier, Green, Wu, Frymire, Kopp and Kiran2021; Khattar et al., Reference Khattar, Anderson, De Rubeis, de Groh, Jiang, Jones, Basta, Kirkland, Wolfson, Griffith and Raina2023). However, age-related stigma often leads to assumptions that older adults are unable to use digital health technology such as smartphones and mobile apps (Mace et al., Reference Mace, Mattos and Vranceanu2022). Digital ageism refers to judgmental thoughts or discrimination against individuals based on their age and their use of digital technology (Manor and Herscovici Reference Manor and Herscovici2021). Many health care providers also assume that older adults do not have the skills to use digital health, which unfortunately excludes older adults from participating in different clinical trials for digital health (Mace et al., Reference Mace, Mattos and Vranceanu2022).
According to the Government of Canada (2020), 3 out of 5 older adults aged 65 years and older have at least 1 of 10 common chronic diseases in Canada. Patients with multiple chronic conditions, or comorbidity, are at higher risk of severe disease outcomes and require standard health care support (Canadian Institute of Health Information, 2011). Older adults are at higher risk of critical medical needs and hospitalization for improved health care services (Canadian Institute of Health Information, 2020). Managing multiple health conditions, specifically chronic disease, and accessing health services are among the biggest challenges for older adults and their caregivers. Sometimes older adults and caregivers face challenges in accessing proper support and become frustrated with long waiting times, especially during emergency support (Ploeg et al., Reference Ploeg, Matthew-Maich, Fraser, Dufour, McAiney, Kaasalainen, Markle-Reid, Upshur, Cleghorn and Emili2017). This creates a barrier for quality care and results in decreased quality of life, especially for a patient with chronic disease who needs regular follow-up care. Few older adults also share that they experience challenges with resources such as an inadequate number of home care hours to meet complex needs (Ploeg et al., Reference Ploeg, Matthew-Maich, Fraser, Dufour, McAiney, Kaasalainen, Markle-Reid, Upshur, Cleghorn and Emili2017). So, it is crucial to plan a feasible service model to ensure accessible health care for older adults in Canada.
COVID-19 has severely impacted health service management in Canada, like other countries, and resulted in deteriorating health. Older adults experienced reduced quality of life due to the pandemic (Choukou et al., Reference Choukou, Sanchez-Ramirez, Pol, Uddin, Monnin and Syed-Abdul2022). However, Canada has been increasingly integrating digital health technologies (such as mobile apps, telehealth, text messages, and chatbots) into its healthcare system to improve access, efficiency, and quality of care (Hackett et al., Reference Hackett, Brennan, Smith Fowler and Leaver2019). Evidence shows that mHealth and telehealth have improved attitudes and self-care practices towards digital health among older adults (Ashraf et al., Reference Ashraf, Gallant and Bradley2023; Howard et al., Reference Howard, Robinson, McKenzie, Fyles, Sudore, Andersen, Arora, Barwich, Bernard, Elston, Heyland, Klein, McFee, Mroz, Slaven, Tan and Heyland2020; Jaana et al., Reference Jaana, Sherrard and Paré2019). Digital technology’s challenges include limited digital literacy, lack of access to technology, or concerns about privacy and data security (Marcotte, Reference Marcotte2022). Evidence also shows some initiatives that have focused on promoting digital literacy to eliminate the stigma related to digital ageism, which refers to age-based discrimination, stereotypes, and assumptions that older adults are unable or less capable of using digital technologies and online environments (Manor & Herscovici, Reference Manor and Herscovici2021; Marcotte, Reference Marcotte2022). However, there has been limited evidence on the dissemination of this initiative at the community level to reach most people to promote digital health and well-being in later life.
Anti-oppressive theory provides a framework for this paper. The theory is used by social workers and other health professionals to address and evaluate different forms of oppression at the individual and institutional levels, based on socioeconomic status, ethnicity, and gender. The theory is helpful for providing insight into current digital health initiatives (Strier, Reference Strier2007). This theory helps to identify the potential role of social workers, gerontologists, and policymakers in reducing the burden of digital ageism and promoting digital health. The aim of this policy and practice note is to critically analyze existing initiatives in digital health service management for older adults in Canada to ensure accessible health care and improve the quality of life. We will also explore digital ageism in health service management and analyze what initiatives have been taken to promote digital health. Lastly, we will identify potential recommendations and connect them to the practical implications to mitigate the burden of digital ageism.
Methods
Study design
This study employed a critical narrative review design to examine digital health initiatives for older adults in Canada through an anti-oppressive theoretical lens. A narrative review was selected due to its suitability for synthesizing heterogeneous sources, including empirical studies, policy documents, and grey literature, while enabling theoretically informed and critical analysis of complex health system issues (Arksey & O’Malley, Reference Arksey and O’Malley2005; Green et al., Reference Green, Johnson and Adams2006). This approach is particularly appropriate for examining multidimensional topics such as digital health and aging, where both empirical evidence and policy context are essential.
Search strategy and data sources
A structured literature search was conducted across four electronic databases: PubMed, Scopus, CINAHL, and Google Scholar. The search strategy combined keywords and subject headings related to: (a) population (“older adults,” “aging,” “elderly”), (b) intervention (“digital health,” “telehealth,” “eHealth,” “mHealth”), (c) access and utilization (“digital literacy,” “access,” “use”), and (d) equity constructs (“digital divide,” “ageism,” “health inequities”).
To enhance policy relevance, grey literature sources were systematically reviewed, including reports and program documentation from Canadian institutions such as the Canadian Institutes of Health Research (CIHR), AGE-WELL, and governmental agencies. Reference lists of selected studies were also hand-searched to identify additional relevant sources (Supplementary Materials).
Study selection and inclusion criteria
The initial search yielded 360 records, including 312 from academic databases and 48 from grey literature sources. After removal of duplicates (n = 72), 288 unique records remained for screening. A two-stage screening process was applied. First, titles and abstracts were reviewed, resulting in the exclusion of 198 records that did not meet inclusion criteria, primarily due to lack of relevance to older adults, digital health, or the Canadian context. This process yielded 90 articles for full-text review.
Second, full-text articles were assessed against predefined inclusion criteria. A further 52 records were excluded due to limited relevance to digital health access or equity, overly technical focus without implications for health service management, or lack of applicability to Canada. The final sample comprised 38 sources, including 22 peer-reviewed empirical studies, eight policy documents, and eight grey literature or program reports (Figure 1).
PRISMA flow diagram.
Figure 1. Long description
The flowchart is divided into three vertical sections.
1. Identification phase at the top. A box contains Studies from databases/registers (n = 360). A horizontal arrow points right to a box for References removed due to duplication (n = 72). A vertical arrow leads to the next phase.
2. Screening phase in the middle. This contains three sequential steps connected by vertical arrows.
- Studies screened (n = 288) with a horizontal arrow pointing to Studies excluded (n = 198).
- Studies sought for retrieval (n = 90) with a horizontal arrow pointing to Studies not retrieved (n = 0).
- Studies assessed for eligibility (n = 90) with a horizontal arrow pointing to a large exclusion box. This box lists Studies excluded (n = 52) with three sub-reasons: Wrong Country (n = 25), Wrong outcomes (n = 17), and No full text paper is available (n = 10).
3. Included phase at the bottom. A final vertical arrow points to the concluding box: Studies included in review (n = 38).
Studies were included if they: (a) focused on older adults (generally aged 60 years and above), (b) examined digital health technologies or interventions, (c) addressed access, utilization, or inequities, and (d) were conducted in or directly relevant to the Canadian context.
Both peer-reviewed and grey literature were included to ensure comprehensive coverage of research, policy, and practice (Supplementary Table S1).
Data analysis
Data were analyzed using an interpretive thematic analysis approach following Braun and Clarke (Reference Braun and Clarke2006). The analysis involved iterative stages that began with repeated reading of the included articles, policy documents, and grey literature to achieve data familiarization and identify recurring patterns related to digital health, aging, access, and equity. During this stage, descriptive notes and preliminary observations were recorded to capture key concepts and emerging issues across the literature. In the second stage, open coding and theme development. Coding was conducted manually by systematically reviewing each source line-by-line. Initial codes were assigned to meaningful segments of text related to digital health access, barriers to technology use, digital literacy, policy initiatives, experiences of exclusion, and representations of older adults in digital environments.
Following initial coding, related codes were grouped into broader analytical categories through a process of constant comparison across sources. Similar concepts were clustered together to identify relationships between technological access, structural inequalities, and experiences of digital ageism. During this stage, codes were refined into key, merged, or reorganized to improve conceptual clarity and reduce overlap through iterative discussion with research team members.
The fourth stage involved developing preliminary themes. Four dominant themes were identified through iterative discussion and review of the codes against the coded extracts to ensure internal coherence and clear distinctions between thematic categories. (a) access and utilization of digital health services, (b) structural barriers and inequities, (c) ageism and digital health in later life, and (d) policy and programmatic responses.
The analysis was guided by an anti-oppressive theoretical framework, which enabled critical examination of how structural factors, such as socioeconomic status, access to technology, and institutional bias, influence older adults’ engagement with digital health systems (Strier, Reference Strier2007). This framework facilitated the identification of systemic inequities and informed the development of equity-oriented interpretations.
Methodological rigor
To enhance rigor and transparency, this study incorporated both peer-reviewed and grey literature, enabling triangulation across research and policy domains. (Arksey & O’Malley, Reference Arksey and O’Malley2005; Green et al., Reference Green, Johnson and Adams2006). The structured screening process, explicit inclusion criteria, and transparent reporting of study selection improve reproducibility (Arksey & O’Malley, Reference Arksey and O’Malley2005; Braun & Clarke, Reference Braun and Clarke2006). Although narrative reviews do not aim for exhaustive systematic coverage, the approach adopted here aligns with established scoping and critical review methodologies and is appropriate for examining complex, interdisciplinary topics (Arksey & O’Malley, Reference Arksey and O’Malley2005). The integration of a theory-driven analytical framework further strengthens the study’s interpretive depth and analytical contribution.
Results
The analysis of 38 sources, including peer-reviewed studies, policy documents, and grey literature, identified four interrelated thematic domains: (a) access and utilization of digital health, (b) barriers and structural inequities, (c) ageism and digital health in later life, and (d) policy and programmatic responses. Together, these themes illustrate both the potential and limitations of digital health systems for older adults in Canada.
Access and utilization of digital health
The findings indicate that digital health technologies have significantly expanded access to healthcare services for older adults, particularly during and following the COVID-19 pandemic. Virtual care modalities, including telehealth consultations, remote monitoring systems, and mobile health applications, have improved continuity of care by reducing barriers related to transportation, mobility limitations, and geographic distance (Bhatia et al., Reference Bhatia, Chu, Pang, Tadrous, Stamenova and Cram2021; Glazier et al., Reference Glazier, Green, Wu, Frymire, Kopp and Kiran2021; Khattar et al., Reference Khattar, Anderson, De Rubeis, de Groh, Jiang, Jones, Basta, Kirkland, Wolfson, Griffith and Raina2023).
Evidence suggests that older adults who are able to effectively engage with digital health tools experience improvements in self-management of chronic conditions, patient engagement, and overall satisfaction with care (Ashraf et al., Reference Ashraf, Gallant and Bradley2023; Jaana et al., Reference Jaana, Sherrard and Paré2019). Digital platforms have also facilitated increased communication between patients and healthcare providers, enabling more timely interventions and monitoring of health conditions.
At the systems level, Canada has increasingly integrated digital health technologies into healthcare delivery, including electronic health records, telemedicine services, and remote care platforms (Hackett et al., Reference Hackett, Brennan, Smith Fowler and Leaver2019; Quellet & Chinho, Reference Quellet and Chinho2022). These developments have contributed to a shift toward more flexible and patient-centred models of care. Digital platforms have also improved care and reduced the need for unnecessary in-person visits, particularly for older adults with mobility limitations, chronic conditions, or those living in rural and remote communities (Bhatia et al., Reference Bhatia, Chu, Pang, Tadrous, Stamenova and Cram2021; Khattar et al., Reference Khattar, Anderson, De Rubeis, de Groh, Jiang, Jones, Basta, Kirkland, Wolfson, Griffith and Raina2023). However, the benefits of digital health utilization remain uneven. While some older adults report positive experiences, others remain excluded due to limited access or capability, indicating that increased availability of digital health services does not automatically translate into equitable utilization across populations.
Barriers and structural inequities
Despite the expansion of digital health services, significant structural barriers continue to limit equitable access and use. A recurring finding across the literature is the persistence of the digital divide, driven by disparities in digital literacy, socioeconomic status, and access to technological infrastructure (Marcotte, Reference Marcotte2022; Wilson et al., Reference Wilson, Heinsch, Betts, Booth and Kay-Lambkin2021). Limited digital literacy remains one of the most significant barriers, particularly among older adults with lower educational attainment or limited prior exposure to technology (Harris et al., Reference Harris, Blocker and Rogers2022). For example, identified difficulties among older adults in navigating and effectively using digital technologies indicate that access to technology alone may not be sufficient to facilitate meaningful engagement with digital health services. Limited familiarity with digital platforms may therefore create additional challenges for older adults who are expected to independently access or navigate technology-mediated healthcare (Harris et al., Reference Harris, Blocker and Rogers2022).
Socioeconomic issues are another crucial barrier reported in the literature. Financial constraints further restrict access to necessary devices, internet connectivity, and digital services, disproportionately affecting low-income populations and those living in rural or remote regions. These challenges can be particularly consequential for older adults with limited financial resources and those living in rural or remote communities, where access to technological infrastructure may already be restricted. Geographic disparities in broadband availability can further constrain the ability of older adults in underserved communities to access digital health services consistently (Marcotte, Reference Marcotte2022).
Privacy concerns and lack of trust in digital systems also contribute to reduced adoption, particularly in the context of health data security (Wilson et al., Reference Wilson, Heinsch, Betts, Booth and Kay-Lambkin2021). Additionally, geographic disparities in broadband infrastructure create uneven access across provinces and communities, reinforcing existing healthcare inequities. These barriers are not isolated but intersect with broader structural inequalities, including income, education, and social exclusion. As a result, digital health technologies risk reproducing and amplifying existing health disparities rather than mitigating them (Kaihlanen et al., Reference Kaihlanen, Virtanen, Buchert, Safarov, Valkonen, Hietapakka, Hörhammer, Kujala, Kouvonen and Heponiemi2022).
The evidence suggests that without targeted structural interventions, digital health initiatives may disproportionately benefit already advantaged populations, thereby widening inequities within the aging population.
Ageism and digital health in later life
There are often stereotypes (digital ageism) that older adults cannot use modern technology or that they have no interest in adapting their skills to the modernization of digital technologies. Especially in the employment sector, there has been discrimination against older adults due to the assumption that they lack skills in digital technology or are not interested in adapting new technologies (Burn et al., Reference Burn, Firoozi, Ladd and Neumark2023). This prejudice regarding digital technology often results in social isolation and older adults do not feel connected within the community (Manor and Herscovici Reference Manor and Herscovici2021).
Older adults face difficulties in accessing digital technologies such as mobile applications, telehealth, and chatbots due to financial issues and lack of knowledge (Harris et al., Reference Harris, Blocker and Rogers2022). As they sometimes do not have the opportunity to use digital technology effectively, they miss the scope of social connection, which results in loneliness among older adults (Balki et al., Reference Balki, Hayes and Holland2022). Evidence shows biases in digital health technology, such as artificial intelligence related to humans, data, and algorithms, which are one of the factors of digital ageism (Chu et al., Reference Chu, Nyrup, Leslie, Shi, Bianchi, Lyn, McNicholl, Khan, Rahimi and Grenier2022). For example, sometimes, AI excludes older adults in algorithm-based research due to social exclusion of the aging population in the use of digital health (Rosales & Fernández-Ardèvol, Reference Rosales and Fernandez-Ardevol2020). Digital ageism contributes to older adults feeling excluded from the broader community. This ultimately impacts stereotypical portrayals in media or when designing any digital health interventions. However, a systematic review showed that using any digital technology reduces social isolation among older adults (Sen et al., Reference Sen, Prybutok and Prybutok2022).
Policy and programmatic responses
A range of policy initiatives and programmatic responses have been implemented across Canada to address the challenges associated with digital health access and digital ageism. These efforts span federal, provincial, community, and private sector levels.
At the national level, strategic initiatives such as the CIHR Institute of Aging Strategic Plan (2023–2028) emphasize developing equitable and accessible digital health systems, highlighting the importance of integrating research, policy, and practice to support healthy aging (Canadian Institutes of Health Research, 2023). Similarly, the Aging in Place Technology and Innovation Program led by the National Research Council Canada focuses on developing age-friendly technologies and community-based innovation through collaborative living labs (National Research Council Canada, 2022).
Multi-stakeholder initiatives, such as the Virtual Stakeholder Symposium on the Future of Aging in Canada, have brought together policymakers, researchers, and industry partners to identify best practices and innovative solutions to address social isolation and improve digital health integration (Candice Pollack Consulting, 2022). These initiatives highlight the importance of cross-sector collaboration in addressing the complex challenges of aging and digital health.
At the community level, numerous programs aim to improve digital literacy and reduce barriers to technology use. For example, Connected Canadians provides one-on-one digital training and support, while HelpAge Canada’s Dig-IT program offers devices, connectivity, and coaching to older adults (Connected Canadians, 2024; HelpAge Canada, 2024). Other initiatives, such as Gluu Society, ABC Life Literacy Canada, and regional programs like the Literacy Society of the North Okanagan and Atwater Library CONNECT program, provide structured training and community-based support to enhance digital inclusion (ABC Life Literacy Canada, 2024; Atwater Library & Computer Centre, 2024; Marcotte, Reference Marcotte2022; Morfaki & Morfaki, Reference Morfaki and Morfaki2022; Reynolds et al., Reference Reynolds, Jeste, Sachdev and Blazer2022; Saskatoon Council on Aging, 2024; The Literacy Society of the North Okanagan, 2024; Welbi, 2016).
These programs demonstrate the potential of targeted interventions to improve digital literacy and engagement among older adults. However, the findings also indicate several limitations. First, many programs operate at a localized level, with limited scalability and uneven geographic distribution. Second, there is a lack of systematic evaluation of program outcomes, making it difficult to assess long-term effectiveness and sustainability. Third, awareness and dissemination remain insufficient, limiting participation among those who could benefit most.
Research and advocacy organizations, including AGE-WELL and the Canadian Association of Gerontology, play a critical role in generating evidence and fostering innovation in digital health for older adults (Candice Pollack Consulting, 2022). Media and public communication platforms also contribute to shaping perceptions and addressing stereotypes, although their impact varies depending on representation and messaging (Zhao et al., Reference Zhao, Crimmins, Zelinski and Choi2022).
Overall, while Canada has made notable progress in developing digital health policies and programs, the current landscape remains fragmented. A more coordinated, evidence-based, and equity-focused approach is required to ensure that these initiatives effectively address structural barriers and reduce digital ageism.
Discussion
This study provides a critical analysis of digital health initiatives for older adults in Canada, highlighting both the transformative potential of digital technologies and the structural inequities that constrain their impact. The findings demonstrate that while digital health has expanded access to care and improved service delivery in some contexts, these benefits are unevenly distributed and mediated by broader socioeconomic and institutional factors.
A key finding of this study is that access to digital health does not equate to equitable utilization. Although virtual care, telemonitoring, and mobile health applications have improved continuity of care, particularly during the COVID-19 pandemic, these technologies remain inaccessible to many older adults due to structural barriers such as limited digital literacy, financial constraints, and inadequate infrastructure (Bhatia et al., Reference Bhatia, Chu, Pang, Tadrous, Stamenova and Cram2021; Glazier et al., Reference Glazier, Green, Wu, Frymire, Kopp and Kiran2021; Wilson et al., Reference Wilson, Heinsch, Betts, Booth and Kay-Lambkin2021). This aligns with broader literature on digital health equity, which suggests that technological innovations often disproportionately benefit populations that are already socially and economically advantaged (Kaihlanen et al., Reference Kaihlanen, Virtanen, Buchert, Safarov, Valkonen, Hietapakka, Hörhammer, Kujala, Kouvonen and Heponiemi2022).
From an anti-oppressive perspective, these findings indicate that digital health systems are not neutral tools but are embedded within existing power structures that shape access and outcomes (Strier, Reference Strier2007). Structural determinants such as income, education, and geographic location play a critical role in determining who benefits from digital health innovations. Without addressing these underlying determinants, digital health interventions risk reinforcing, rather than reducing, health inequities.
Another central contribution of this study is the identification of digital ageism as a systemic and multi-level phenomenon. The findings suggest that digital ageism operates at individual, institutional, and technological levels. At the individual level, stereotypes that older adults are resistant to or incapable of using technology can undermine confidence and reduce engagement (Manor & Herscovici, Reference Manor and Herscovici2021; McCrorie et al., Reference McCrorie, Donnelly and McGlade2016). At the institutional level, such assumptions may influence healthcare providers’ decisions, leading to reduced offering or support for digital health services (Mace et al., Reference Mace, Mattos and Vranceanu2022). At the technological level, design processes often fail to account for age-related needs, resulting in usability challenges and exclusion from digital platforms (Chu et al., Reference Chu, Nyrup, Leslie, Shi, Bianchi, Lyn, McNicholl, Khan, Rahimi and Grenier2022).
This multi-level manifestation of digital ageism contributes to a self-reinforcing cycle of exclusion, in which limited access and engagement are interpreted as lack of ability or interest, further justifying exclusion from digital innovation and service delivery. These findings are consistent with research indicating that older adults are frequently underrepresented in digital health research and development, leading to technologies that are not tailored to their needs (Marston & Musselwhite, Reference Marston and Musselwhite2021).
The analysis of policy and programmatic responses reveals that Canada has made important strides in promoting digital health and addressing digital inclusion. National strategies, such as those led by the Canadian Institutes of Health Research, emphasize equitable access and system integration (Canadian Institutes of Health Research, 2023). Community-based programs, including digital literacy initiatives and intergenerational training models, demonstrate promising approaches to improving digital engagement among older adults (Connected Canadians, 2024; Marcotte, Reference Marcotte2022).
However, these efforts remain fragmented and unevenly distributed, with limited evidence on scalability, long-term sustainability, and population-level impact. Many programs operate at a local level and rely on short-term funding or volunteer support, which constrains their reach and continuity. Furthermore, there is a lack of systematic evaluation frameworks to assess program effectiveness, making it difficult to determine which interventions are most successful in reducing digital inequities. This evidence gap limits the ability to translate successful initiatives into broader policy implementation.
Importantly, the findings suggest that current interventions are predominantly focused on individual-level solutions, such as digital literacy training, rather than addressing structural and systemic barriers. While such interventions are necessary, they are insufficient on their own. A more comprehensive approach is required, one that integrates infrastructure development, affordability measures, inclusive design standards, and policy reforms to reduce systemic inequities (Honeyman et al., Reference Honeyman, Maguire, Evans and Davies2020; Kaihlanen et al., Reference Kaihlanen, Virtanen, Buchert, Safarov, Valkonen, Hietapakka, Hörhammer, Kujala, Kouvonen and Heponiemi2022).
An anti-oppressive framework highlights the need to shift from a model of individual adaptation to one of structural transformation. This includes actively involving older adults in the co-design of digital health technologies, ensuring representation in research and innovation processes, and addressing biases embedded within technological systems. Intergenerational collaboration and community-based participatory approaches may also play a key role in fostering inclusive and accessible digital health ecosystems (Noone & Yang, Reference Noone and Yang2022).
The media and public discourse also play significant roles in shaping perceptions of aging and technology. Positive representation of older adults as capable and engaged users of digital tools can help counteract stereotypes and reduce digital ageism (Zhao et al., Reference Zhao, Crimmins, Zelinski and Choi2022). At the same time, policymakers and stakeholders must recognize that digital inclusion is not solely a technological issue but a broader social and equity concern that requires coordinated action across sectors (Gauthier-Beaupré et al., Reference Gauthier-Beaupré, Battistini, Kuziemsky and Jutai2023).
Implications for policy and practice
The findings have several implications for policy and practice. First, addressing the digital divide requires structural interventions, including investment in broadband infrastructure, subsidization of digital devices and services, and targeted support for low-income and rural populations. Second, digital literacy initiatives should be scaled and integrated into broader health and social care systems to ensure sustainability and reach. For example, digital literacy training could be incorporated into community health centres, primary care services, senior centres, and home care programs, where older adults already access support services. Intergenerational learning models and one-on-one coaching programs, such as Connected Canadians and HelpAge Canada’s Dig-IT initiative, may also improve confidence and long-term engagement with digital health technologies (Connected Canadians, 2024; HelpAge Canada, 2024).
Third, there is a need to establish inclusive design standards that prioritize accessibility and usability for older adults, including consideration of cognitive, physical, and sensory changes associated with aging. For example, simplified user interfaces, larger text and icons, voice-assisted navigation, compatibility with assistive devices, and minimizing complex multi-step authentication processes that may create barriers for older adults with cognitive or visual impairments (Harris et al., Reference Harris, Blocker and Rogers2022). Fourth, policymakers should implement mechanisms to ensure the inclusion of older adults in digital health research and innovation processes. This may include participatory co-design approaches, community-based consultations, and inclusion of older adult populations in digital health pilot testing and evaluation studies (Noone & Yang, Reference Noone and Yang2022; Chu et al., Reference Chu, Nyrup, Leslie, Shi, Bianchi, Lyn, McNicholl, Khan, Rahimi and Grenier2022). Such approaches can help ensure that digital technologies are designed to meet the actual needs, preferences, and lived experiences of older adults rather than to rely on assumptions about aging and technology use.
Finally, systematic evaluation frameworks are needed to assess the effectiveness of digital health programs and inform evidence-based policy development. Without such evaluation, it remains difficult to identify best practices and scale successful interventions. Continuous evaluation using both qualitative and quantitative indicators, including user satisfaction, digital engagement, health outcomes, and long-term sustainability, would help identify best practices and support the scaling of successful interventions (Honeyman et al., Reference Honeyman, Maguire, Evans and Davies2020; Kaihlanen et al., Reference Kaihlanen, Virtanen, Buchert, Safarov, Valkonen, Hietapakka, Hörhammer, Kujala, Kouvonen and Heponiemi2022).
Strengths and limitations
This study contributes to the literature by integrating empirical evidence, policy analysis, and theoretical insight through an anti-oppressive lens. The inclusion of both peer-reviewed and grey literature provides a comprehensive perspective on digital health in Canada.
However, several limitations should be noted. As a narrative review, the study does not aim to provide exhaustive coverage of the available literature and may be subject to selection bias. Additionally, the reliance on secondary data limits the ability to assess causal relationships or program effectiveness. Future research should incorporate primary data and longitudinal designs to better understand the long-term impact of digital health interventions on older adults, particularly regarding digital literacy, health outcomes, social connectedness, and equitable access across diverse populations. Comparative studies across rural and urban settings, as well as systematic reviews and meta-analyses, would also help identify best practices and strengthen the evidence base for digital health policy and program development.
Conclusion
This paper highlighted an important issue of ageism in digital health, current policy, and possible recommendations to overcome this concern. Community awareness is crucial to reduce stigma and emphasizing the importance of digital health for older adults to ensure quality care. Policymakers have already taken initiatives, but it is also important to design a community-driven, feasible digital health intervention to improve healthcare accessibility, especially for older adults with chronic diseases. Caregivers play an important role in healthcare decision-making. It is also crucial to provide them with appropriate information to understand their perspective on digital health and identify their preferences for services such as eHealth, telehealth, mHealth, or other sources. Media also play a crucial role in breaking the stigma related to digital ageism and portray positively about older adults using digital health in their daily lives. The anti-oppressive theory is helpful for exploring initiatives and ensuring an accessible, user-friendly digital health service that addresses systemic barriers and fosters healthcare accessibility. Hopefully, by addressing the stigma of ageism, it will be possible to develop an effective service model for older adults for accessible health service management.
Supplementary material
The supplementary material for this article can be found at http://doi.org/10.1017/S0714980826100890.
Acknowledgments
We would like to express our gratitude to the Canadian Journal of Aging for providing us with the opportunity to share our work. We also wish to acknowledge the support provided by our colleagues who contributed to furnishing this manuscript.
Open access
