Digital Health Adoption and Sustained Use Among Older Adults

Abstract Background: Digital health is increasingly used to support healthcare delivery for older adults, but availability does not necessarily lead to adoption or continued use and engagement. Understanding the factors that influence adoption and sustained use is important for effective and efficient healthy-ageing strategies. Objective: To examine determinants of digital-health adoption and sustained use among older adults and compare these factors across India, Canada, the United States, Germany and the Netherlands. Methods: A comparative scoping review was undertaken using evidence published from January 2010 to August 2026. PubMed, openly accessible scholarly sources, targeted web searches and authoritative national and health-system sources were examined. Evidence was synthesised thematically across access, digital-health capability, perceived value and usability, trust and care preferences, social and professional support, initial adoption, sustained use and equity. Twenty-seven core sources were included. Results: Digital-health engagement was shaped by multiple interacting factors rather than technology availability alone. Access, affordability and digital literacy were particularly important in India, while socioeconomic and geographic inequalities remained relevant in Canada and the United States despite established digital infrastructure. Germany demonstrated persistent digital-health-literacy inequalities, whereas evidence from the Netherlands highlighted usability, reliability and fit with users' needs. Across all five countries, evidence on sustained use remained less developed than evidence on initial adoption. Conclusion: Digital-health adoption among older adults is a multidimensional engagement challenge. Initial adoption and sustained use should be evaluated separately, with equity and human support considered across both. Strategies should combine usable technologies with digital-literacy support, human assistance, privacy safeguards and appropriate hybrid care.