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Abstract

Background

Digital health technologies (DHTs) promise enhanced health for older people, yet the digital divide hinders adoption and utilization. This study aimed to identify DHTs that can help older people in chronic disease management, specifically the facilitators, barriers, needs, and scenarios.

Methods

We searched PubMed, Embase, Cochrane Library, Web of Science, Scopus, and IEEE for studies published in English between 2000 and 2024. Analysis of included articles included descriptive synthesis and thematic analysis.

Results

Forty-seven studies were included, yielding 148 DHTs classified as Medical services and support (n = 94) or Self-management (n = 54). Experience of Use and Interpersonal Support were the main facilitators of the use of DHTs. Awareness of Competence, Technological Factors, Sense of Security, and Individual Factors are barriers. Needs can be categorized into Service Functions and Subjective Needs, and the main scenarios include Home, Community, and Hospital.

Conclusions

Digital health technologies are widely used, especially in developed countries, but challenges remain in developing countries and among specific patient. Future studies should focus on addressing concerns about DHT availability, security, and reliability in older people, actively incorporating feedback, providing personalized service, and fully mobilizing positive social factors to promote DHTs.

Keywords

Digital health technologies older people aging chronic disease scoping review

Introduction

Population aging has become an important challenge shared by the whole world, with developed countries entering into heavily aging societies, developing countries experiencing a demographic transition to low fertility and low mortality.^1,2 Chronic noncommunicable diseases pose a serious threat to human life and health.³ Health care for older people with chronic diseases is no longer a single individual's behavior but requires the concerted efforts of the entire society.⁴ The rapid development of information technology has continuously revolutionized and driven the traditional chronic disease care model to a new stage of digital health, enriching the chronic disease management model.^5–7 In personal health management, DHTs (digital health technologies) are even more valuable for older people with chronic diseases.⁷

Countries around the world are focusing on the strategic layout and innovative practices in the field of digital health, promoting the in-depth integration of technology, products and operations, and digital health in the field of elderly chronic disease has been deeply explored and researched.^8,9 One review compiled information concerning the development of DHTs and categorized them as five big PHC functions, but lacked details about the distribution characteristics of DHTs.¹⁰ Obviously, many studies have highly affirmed the prospect of DHTs which is considered to have a significant value in improving the health of the elderly.^11–13

However, the digital divide is becoming more pronounced among older adults with chronic diseases. Due to their physical weakness, language barriers, financial challenges, and low educational background, it is becoming more difficult for older adults to adopt and use DHTs, and the risk of digital divide is increasing.^14,15 Good digital health literacy can lead to better acceptance and use of DHTs among older adults, lack of digital health literacy often leads to a higher likelihood of developing chronic health conditions.¹⁶ Shin found that digitally stored health data and information creates a validity bias in the public perception of digital health, and that patients who have difficulty applying them will have difficulty meeting their health needs.¹⁷ Older people with chronic diseases who actively participate in health resource sharing through DHTs are able to sustainably improve their emotional fulfillment and self-efficacy, which further strengthens their social interactions and healthiness of life.¹⁸

Many studies have shown that the utilization and frequency of mHealth technology is not high, and there are significant challenges to the acceptance of DHTs, especially among the older age groups.¹⁹ Widespread use of new technologies cannot be separated from the in-depth research on the factors influencing individuals’ adoption of new technologies. However, we found that the majority of reviews on similar topics focus on the effectiveness of DHTs for older adults, such as feasibility, cost, adherence, and health outcomes.^12,20,21 Some studies focuses on the opportunities and challenges of using mobile health in elderly self-care, but the scope of the population is too broad, and the type of DHTs is relatively simple, conclusions don’t have good representativeness for elderly people with chronic diseases, who are particularly vulnerable and need care.^22,23 This further proves the importance of our research, we provides valuable insights into the adoption of DHTs among older people with chronic diseases.

This study aims to evaluate recent literature, with a focus on the current use of DHTs in older people with chronic diseases, particularly the relevant influencing factors (facilitators, barriers, needs, scenarios). Through this assessment, the study aims to propose support strategies to improve their services in a targeted manner and propel progress in this critical domain of health care.

Methods

Search strategy

The protocol for this review can be accessed at the Open Science Framework.²⁴ We strictly followed the guidelines of Preferred Reporting Items for Literature Review and Meta-Analyses²⁵ (see Appendix A for the PRISMA Checklist).

Our review was conducted in six databases: PubMed, Embase, Cochrane Library, Web of Science, Scopus, and IEEE, with a publication period from January 1, 2000, to December 1, 2024. Search strategy was developed by two professional researchers (CL and LZ) with the help of librarians, mainly based on three selected keywords: “Digital Technology,” “Chronic Diseases,” AND “Elderly.” We didn’t distinguish whether elderly suffer from a single or multiple chronic diseases, and strictly followed the International Classification of Diseases to classify chronic diseases, which improved the clarity of the review.²⁶ The query searched the title and abstract fields. All search fields were searched for the of IEEE Explore database because limiting the search fields to the titles and abstracts would result in no articles. The complete search strategy is provided in Appendix B.

Eligibility criteria

All literature was managed using NoteExpress software, two professional researchers (CL and HW) independently completed an initial literature screening according to inclusion and exclusion criteria (see Textbox 1), a third senior researcher (AO) made a comprehensive determination if the screening results were divergent. We had a three-step selection process: screened titles and abstracts to identify eligible studies, assessed the full text to determine relevance, and ensured that only studies aligned with our objectives were included. In addition, we excluded publications in any language other than English, reviews were excluded because we have objectively discussed relevant reviews on the same or similar topic in the background.

Textbox 1.

Inclusion and exclusion criteria

Inclusion criteria:

The type of study design was quantitative, qualitative, or mixed;

Patients were 60 years of age or older (including all genders, regions, and ethnicities);

Diagnosed with one or more chronic diseases;

The topic of the study was about the facilitators, barriers, scenarios, and needs for DHTs;

Exclusion criteria:

Duplicate literature;

Digital health intervention technologies that do not target people aged 60 years or older or chronic diseases;

Studies that deviate from the research topic;

Review, gray literature, protocols, conference papers, letters, and other literature without full text;

Data extraction and analysis

We created an Excel spreadsheet form to use in data extraction. Descriptive data of all the included literature were extracted and integrated in this study, including title, author, country, time of publication, type of study, study perspective, and type of chronic disease covered. Keywords of the included literature were visualized and presented using CiteSpace software.

We used NVivo 12 to create a coding scheme under four thematic categories: (1) facilitators, (2) barriers, (3) needs, and (4) scenarios. The complete article was imported into NVivo 10 as a pdf file and was coded back-to-back by two professional researchers (CL and YJ). Firstly, researchers read and encoded all texts that met the themes sentence by sentence to extract concepts, then, continuously analyzed the internal logic between concepts and condensed them into categories, finally, further explored the attributes of different categories to integrate them into scheme, and calculated the proportion of each category in the corresponding scheme. The controversial content will be discussed and identified with the other two professional researchers (LS and YC).

Results

Overview

Through initial search, we obtained 2117 articles. After removing 1204 duplicates and reading the titles and abstracts, 168 articles were considered. Upon full-text review, the final 47 articles were eligible for inclusion. This process is shown in Figure 1.

Figure 1.

PRISMA flow diagram for the scoping review.

Keyword co-occurrence network

In Figure 2, by mapping the keyword co-occurrence for the abstracts of 47 literatures through CiteSpace, we found four main Key words: care, digital health, technology, and older adults, which almost matched the search themes we identified. In addition, we found the keywords with high frequency including COPD, mobile health, barriers, communication, e-health literacy, acceptance, perception, experience, education, support, and behavior, which provided important help for the thematic analysis we then carried out.

Figure 2.

Keyword's main themes and concepts.

Data summary

We provide a summary of each included study in Supplementary Table 1 (see Appendix C). The number of studies published in 2024 was the highest. By region, 20 studies were from Europe, 14 from North America, and 13 from Asia, with the highest number of published regions being Canada (n = 8). By type, there were 10 quantitative studies, 33 qualitative studies, 4 mixed studies. By the study perspective, there were 34 studies based on the perspective of older people with chronic diseases, 5 studies from the physician perspective, and 8 studies covering both perspectives.

Table 1.

Overview of the facilitators for older people with chronic disease using DHTs.

Facilitators	Category	Frequency (%)	References
Experience of use	Effectiveness	29 (33.72%)	^{28,29,31–35,39,42,44,47,48,51–54,56–58,60–64}
	Successful use	22 (25.58%)	^{29,31,33,35,36,39,42,44,47,49,51–53,55,58–60,62,63,69}
Interpersonal support	Doctor–patient communication	22 (25.58%)	^{27,29,31,34,35,38,45,48,51,53,55,57–60,65–68}
	Family support	7 (8.14%)	^{32,44,49,63,64}
	Trust	6 (6.98%)	^{31,48,51,57,66,67}

By type of chronic disease, 14 studies did not specifically describe the type of chronic disease, 16 studies focused on a single chronic disease, and 17 studies focused on multiple chronic diseases, all included studies cover 16 chronic diseases, among which COPD (n = 20), type 2 diabetes (n = 10), heart failure (n = 6), and hypertension (n = 4) are the most concerned. Dementia is a chronic disease that requires great attention, due to poor understanding ability of the elderly, it greatly increases the difficulty of interviews or surveys, so many studies did not consider these people. Since there are many kinds of chronic diseases, we will analyze the distribution characteristics of DHTs mainly based on above four chronic diseases.

Types of DHTs

In Figure 3, the functions of DHTs can be generally categorized as Self-management and Medical services and support. In Medical services and support, DHTs is an effective tool to help older people with chronic diseases more conveniently access healthcare services and meet their medical needs and to help healthcare providers optimize the process of healthcare services and improve the efficiency of healthcare services. Health tracking diary is the most commonly used function, where patients actively record physiological indicators such as blood pressure, and daily life such as sleep quality and diet, the program automatically analyzes and generates reports, providing evaluation basis for doctors and patients. Online health education provides a platform where doctors provide personalized content based on the health status of each older adults, encouraging them to change unhealthy behaviors and lifestyles. Patient medication management is to remind and supervise patients on medication dosage to improve medication compliance. Remote disease monitoring system constructs a regional collaborative medical service platform or relies on devices similar to telepresence robot technology to monitor the management of chronic diseases in the elderly in real time.

Figure 3.

Categories of digital health technologies (DHTs).

In self-management, DHTs is mainly used to improve the quality of life and physical health of older people with chronic diseases, rather than being limited to disease management. Physiological data monitoring tools are the most widely used digital technology. Internet health consultation is a low-cost and convenient service provided by a third-party platform, which covers health assessment, health guidance, medical advice, health education and other nondiagnosis and treatment activities. Disease information query provides patients with information related to chronic diseases, to achieve the correct understanding and scientific management. Disease self-diagnosis assessment utilizes internationally recognized chronic disease assessment scales, allowing patients to conduct health assessments at home. Family mutual aid platform promotes patients to share information with their family or friends. Home alarm devices mainly rely on behavior sensing systems and Internet of Things technology. Home intelligent robots provide elderly people with care services such as household cleaning, health management, and emotional companionship, greatly improving the convenience and quality of life.

Distribution of DHTs

Comparing by time, we can see from Figure 4 that self-management was almost equal than Medical services and support from 2014 to 2016, while Medical services and support had more number of apps after 2017, and from 2017 to 2019 it was mainly focused on Health tracking diary (n = 5).^27–31 In 2020 to 2022, the number of Medical services and support and Self-management significantly increased, mainly concentrated in Health tracking diary (n = 8),^32–39 and Intelligent wearable device (n = 5).^{34,35,37,38,40} It is worth noting that Disease self-diagnosis assessment, Family mutual assistance platform, Home robot only appeared after 2020. In 2023 to 2024, the number of Medical services and support is still increasing, mainly focused on Health tracking diary (n = 8),^41–48 the number of Self-management has decreased, mainly focused on physiological data monitoring tools (n = 6).^{41–44,48,49}

Figure 4.

Application of digital health technologies (DHTs) in different periods.

Comparing by region, we can see from Figure 5, the largest number of DHTs were covered in Europe, with Medical services and support focusing on Health tracking diary (n = 7),^{27,29,31,34,35,37,38} Self-management focusing on Intelligent wearable device (n = 6).^{34,35,37,38,40,50} The number of Medical services and support in North America and Asia is higher than that in Self-management. Especially in Asia, the number of Self-management is very small, and Home robot, Home alarm devices, Virtual health coach, Disease self-diagnosis assessment is not involved.

Figure 5.

Application of digital health technologies (DHTs) in different regions.

Comparing by disease, we can see from Figure 6, Health tracking diary was most commonly used in these four types of chronic diseases, and it is worth noting that the Family mutual assistance platform, Disease self-diagnosis assessment were all found in the COPD population, and Virtual health coach was found in the Diabetes population. The most commonly used technologies among COPD are physiological data monitoring tools and physician patient interaction platforms.

Figure 6.

Application of digital health technologies (DHTs) in different chronic diseases.

Categories of digital health

Overview

In the 31 studies included, we explored four categories of DHTs for older people with chronic diseases: (1) Facilitators, (2) Barriers, (3) Needs, and (4) Scenarios. Regarding the Facilitators, we have confirmed the Experience of Use^{28,29,31–36,39,42,44,47–49,51–64} and Interpersonal Support.^{27,29,31,32,34,35,38,44,45,48,49,51,53,55,57–60,63–68} Regarding the Barriers, we have confirmed the Awareness of Competence,^{27,30,31,36,39–41,43–46,48,50–52,57–64,66,67,69–72} Technological Factors,^{27,28,30,31,34–36,39,40,42–45,48–54,56–64,69,71,73} Sense of Security,^{28,29,31,33,35,36,38–40,43–45,48–54,57–64,66,69–71} and Individual Factors.^{28,33,36,39–41,43–46,51,52,56,58,64,67–69} Regarding the Needs, we have confirmed the Service Functions^{28,29,32,33,36,38–49,51–55,57,60,63,65,66,69,70} and Subjective Needs.^{41–49,51–53,69} Regarding the Scenarios, we have confirmed the Home,^{27–35,38–44,47–56,58,59,61–63,65,66,68–71,73} Community,^{36,37,45,57,60,64,67} and Hospital.^46,72

Facilitators

In Table 1, Effectiveness is the main driving force behind the use of DHTs among older adults, who focus on improving their quality of life, promoting health, providing medication advice, helping with dietary and nutritional management, and increasing physical activity. Successful use includes both easy-to-use technology and successfully mastering technological knowledge. In doctor–patient communication, feeling cared for and listened to is important, if they have long-term and effective communication with doctors, regularly share health information, and even receive some incentives (money, praise, etc.), they will be more willing to participate. Moreover, trust in the abilities of healthcare professionals is crucial.

Barriers

In Table 2, in awareness of competence, lack of experience and knowledge, limited learning ability, and spending many time learning greatly weaken the receptivity of older adults. Some people lack interest, manifested as resistance to new technologies or low initiative to learn.

Table 2.

Overview of the barriers for older people with chronic disease using DHTs.

Barriers	Category	Frequency (n)	References
Awareness of competence	Receptivity	32 (15.17%)	^{30,31,36,37,39,41,43–45,50–52,57–64,66,67,69–71}
	Interest	18 (8.53%)	^{36,39,40,45,46,48,57,59,61–63,69–72}
	Awareness of use	12 (5.69%)	^{27,31,36,39,43,45,58,59,63}
Technological factors	Individualized features	28 (13.27%)	^{27,28,30,31,42–44,49,51–54,59,60,62,63,69}
	Technical faults	19 (9.00%)	^{27,34–36,39,40,42,44,45,52,54,57,58,60,61,63,64,73}
	Communication form	10 (4.74%)	^{39,48,50,56,59–61,63,64,71}
Sense of security	Privacy protection	21 (9.95%)	^{28,29,33,36,39,40,44,48,49,51,52,54,58,60,61,63,64,69,70}
	Technology anxiety	21 (9.95%)	^{31,35,43–45,48–50,52,54,57,59,63,64,71}
	Authenticity of information	18 (8.53%)	^{35,36,38,39,43–45,48–50,52,53,58,60,62,63,66}
Individual factors	Economic status	12 (5.69%)	^{28,33,36,39,41,51,52,58,64,67,68}
	Age	9 (4.27%)	^{28,33,41,43–46,56,68}
	Education level	8 (3.79%)	^{28,33,40,41,43,56,68,69}
	Health status	3 (1.42%)	^28,33,43

About technological factors, some DHTs lack personalized design, manifested as inadequate navigation functions, lack of targeted health education, insufficient language affinity, difficult-to-read icons and fonts, complex, and unnecessary service functions. New technologies will change the communication form; they are worried that they will reduce opportunities for face-to-face communication, social networking, and physical activity, which will make them feel lonely.

The lack of security is very tricky; most people are concerned about privacy breaches and online fraud and are unwilling to share health information. Technical anxiety is very common, elderly people worry about difficulty in dealing with urgent health conditions, mastering technical knowledge and adapting to updated and upgraded technologies, they feel oppressed when completing daily health tasks, often under the pressure of being monitored, and some negative technological news also makes them psychologically resistant. The authenticity of physiological monitoring data and Internet information, and the credibility of DHTs confuse the elderly.

Needs

In Table 3, Service Functions is the largest category for promoting DHTs, the elderly hope that digital technology can provide medication lists, develop scientific medication strategies, and promptly remind medication users. Also, older people hope that doctors have rich digital technology skills, empathy, and communicate with them through video, deeply participate in the process of formulating health plans, and increase the frequency of communication. About personalization, older people hope to obtain targeted disease information, help in reducing stress, and digital technology can automatically transmit their health information to doctors. Moreover, DHTs should have operability, manifested as being easy to carry, safety and reliability, having clear and simple page design, and providing instructional guidance for upgrading functions.

Table 3.

Overview of the need for older people with chronic disease using DHTs.

Needs	Category	Frequency (n)	References
Service functions	Doctor–patient cooperation	20 (15.75%)	^{29,33,38,44–49,53,55,57,65,70}
	Operability	23 (18.11%)	^{28,33,39,41–48,51–54,60,69,70}
	Personalized design	19 (14.96%)	^{28,29,32,36,43–45,47,51–55,57,65,69,70}
	Medication management	12 (9.45%)	^{32,33,53,55,57,65,66,70}
	Health education	12 (9.45%)	^{33,36,40,44,55,57,63,70}
	Physiological data monitoring	5 (3.94%)	^{36,40,48,55,70}
	Health diary	5 (3.94%)	^{33,36,38,53,55}
Subjective needs	Capability	12 (9.45%)	^{28,41–43,45,46,48,49,52,57,60,69}
	Children's support	8 (6.30%)	^{36,44,45,51,53,57,69,70}
	Mutual help among patients	7 (5.51%)	^{44,45,47,49,51,53,66}
	Literacy	4 (3.15%)	^28,44,45,63

In subjective needs, Regular guidance and education are needed to enhance the elderly's ability to use DHTs and improve their digital literacy to be open to new technologies. In addition, older people have a strong desire to share information with their family and friends.

Scenarios

Home is the largest scene that adopts DHTs among older people with chronic diseases, mainly manifested in the following four areas: (1) using mobile health technology to monitor and collect disease data, online health consultation with specialists, online outpatient appointments, etc.; (2) developing telemedicine technology, using digital health platforms for telemedicine videos, health tracking diaries, self-diagnostic assessment of diseases, etc. using the Internet to access medical documents online; (3) using the Internet to access medical documents, query chronic disease information, etc.; (4) using smart wearable devices to measure vital signs in real time, and fall alerts for the elderly at home, etc.

Seven studies focused on communities, one Swedish study focused on the beliefs, attitudes, experiences, and expectations of people about DHTs in primary health care.⁵⁷ One Canadian study focused on the use of smart phones by diabetes patients in community health care.⁶⁷ Another Canadian study explored the potential characteristics for successful adoption of health management apps by doctors and patients.³⁹ A Norwegian study explored the use of DHTs by doctors to prevent fewer hospitalizations among home-bound older people receiving community-based care.³⁷ One UK study focused on the feasibility and potential effectiveness of a social network map assessment tool in Community Care for COPD Patients.⁶⁴ One Dutch study focuses on the needs, barriers, and facilitators of older people in the community using DHTs to access general practice services.⁶⁰ Korean study focuses on the preparation, challenges, and opportunities for implementing DHTs.⁴⁵

Only two study focused on DHTs in hospital scenarios, one exploring the perceptions of medical staff on interprofessional collaboration in the use of DHTs for medication management,⁷² and the other exploring patients’ perceptions of doctors’ use of DHTs in clinical care.⁴⁶

Discussion

Main findings

In this study, we found relevant scientific papers on the use of DHTs in older people with chronic disease. Currently, DHTs have been widely used and promoted in the older people with chronic disease. Digital health technologies can be summarized as Medical services and support and Self-management, we have drawn meaningful conclusions by exploring the distribution characteristics of these technologies over time, region, and disease. More importantly, we identified four schemes: facilitators, barriers, needs, and scenarios. The Facilitators category contained Experience of Use, Interpersonal Support, and the Barriers category contained Awareness of Competence, Technological Factors, Sense of Security, Individual Factors, the Needs category contains Service Functions, Subjective Needs, The Scenarios category contains Home, The Scenarios category contains Home, Community, and Hospital.

Current Status of DHTs

In terms of time span, the number of studies is generally showing an upward trend, with a blowout growth in the number of studies in 2020 and 2024, which is closely related to the outbreak of the new coronavirus pneumonia and the mature application of technology.⁷⁴ Digital health technologies breaks the traditional healthcare service model and improves the accessibility and convenience of healthcare services to a great extent, there have been many studies on DHTs use for chronic disease management during the pandemic, but not necessarily focused on the elderly, our review fills the research gap in this field.^75,76 The focus of research has evolved over time, early research, which focused more on physiological data monitoring tools and Internet health counseling services, subsequently, a variety of communication tools became popular, this is because the elderly hope to establish more social connections and share their lives with others on the basis of meeting health management needs.⁷⁷ James believed that social network interventions are a low-cost, high-yield social resource.⁷⁸ Although only seven studies in our review addressed the social connection of older people with chronic diseases, this may change in the near future as new information tools are rolled out.^79,80

Geographically, developed countries in Europe and the United States have conducted the most in-depth research on the use of DHTs in older people with chronic diseases, particularly in the use of mobile devices to facilitate information exchange and feedback between doctors and patients and family mutual aid platform, because it can effectively improve the digital literacy of the elderly, enhance their initiative and enthusiasm to adopt and use self-management technologies.^53,81 It can be seen that more technologies with higher levels of intelligence will be applied to the management of chronic diseases among the elderly. Niakan Kalhori et al. also proposed similar conclusions in their review.⁸² However, some studies worried that it may increase the possibility of providing health interventions to older people who have difficulty accessing health resources.^83,84 Heoretical study and achievement transformation of DHTs is more limited in developing countries. Both the number of studies and the scope of DHTs adoption lag far behind developed countries, with doctor–patient communication still using SMS for health management, and low cost and low network requirements facilitating the spread of apps, especially more prevalent in low-income countries, this is because many regions have immature digital technology, do not attach importance to self-management, and still rely on medical institutions to provide care services for the elderly.^85,86 In addition, we found that over half of the research in Asia was conducted in 2024, indicating that DHTs are increasingly being valued in chronic disease management.

In terms of the types of chronic diseases, the chronic disease population with the most use of DHTs is COPD patients, on the one hand, COPD has become a global public health problem with high prevalence and mortality rates,⁸⁷ on the other hand, the new coronavirus pneumonia has exacerbated the prevalence of COPD, which in turn has led to a dramatic increase in the demand for medical care for COPD patients.⁸⁸ We found that the most involved DHTs were health tracking diaries and online communication platforms for doctors and patients. This is broadly in line with the findings of a number of other studies, most of which used telehealth technologies for COPD management, where mobile devices and virtual technologies are widely used to deliver health interventions outside of healthcare settings.⁸⁹ Lundell et al. showed through a meta-analysis that telemedicine improved physical activity in patients with COPD but had no significant effect on patients with dyspnea.⁹⁰ However, the Hanlon study found no significant impact of telemedicine on reducing mortality and improving health outcomes in COPD patients.⁹¹ Sul et al. study shows similar results found in meta-analysis of telemedicine.⁹² Whether DHTs can improve the quality of health management for COPD patients still requires further research.

Adoption of DHTs

Older people with chronic diseases have positive attitudes towards the acceptance of DHTs, but they are also affected by several factors. Effectiveness and interpersonal support are the main factors, older people hope to obtain advice on medication use and physiological data monitoring, DHTs help improve dietary and nutritional management, increase daily physical activity, and significantly reduce sedentary time through the use of DHTs to achieve the goal of improving quality of life and promoting health has greatly increased the initiative and motivation of older persons to use DHTs.^93,94 Older people are better able to acquire knowledge and competence in DHTs through independent learning or with the help of others, so that they can gain more confidence and interest in embracing and exploring the potential of DHTs for use in daily life and chronic disease management.^58,59,69 Doctor–patient communication is particularly influential in interpersonal support, where doctors or nurses follow up on the health status of older people with chronic diseases over time by phone or video, so that older people feel cared for and listened to.^45,95

Being able to share with healthcare professionals the results or difficulties of using DHTs, and believing that using DHTs is a very important thing to do helps reduce isolation and feelings of being misunderstood.^34,48,51 It is also important to have a trusting relationship between older people with chronic diseases and their healthcare providers, and trusting the healthcare provider is a prerequisite for talking about health conditions and experiences with DHTs.^51,57 In addition, spouses or children of older people with chronic diseases who help them learn about DHTs and remind them to use them in their daily lives can similarly change older people's attitudes and frequency of DHTs use,^54,64 Asia has started to pay attention in recent years.

Awareness of competence is a notable issue among the factors influencing older people with chronic diseases themselves. Most studies have found a general lack of experience and knowledge in the use of DHTs among older people with chronic diseases, with some older people believing that DHTs are too complex and require a lot of time and effort to learn.^30,45 Frustration or failure in learning or use will completely demotivate older adults to learn DHTs.^59,69 Some studies have found that some older adults lack interest in DHTs and even have an aversion and resistance to new technologies, and that the digital divide, traditional culture, limited technological skills and information-seeking behaviors increase older adults’ technological anxiety and resistance to change.^60,69 Many studies have found that digital literacy positively impacts individuals’ physical and mental health.^96–98

It is necessary to involve the elderly in the DHTs design process, some designs are not friendly to the elderly, such as complicated logins, unclear navigation, and difficult to read fonts, which also reduces motivation to learn.^43,48,52,99 Especially in recent years of research, many older people have expressed a desire to participate in design technology.^44,46,47 In addition, technological failures are of greater concern, older people with chronic diseases are prone to frustration, anger and disappointment when they encounter problems with network signals, hardware failures, etc., which leads to a reluctance to use DHTs again in older adults.^31,45,54

Digital health technologies have changed the forms of social communication for older people, with less face-to-face contact via cell phones or the internet, makes people more distant from each other, older people with chronic diseases are more inclined to go to the hospital in person to buy medicines or queue up for outpatient appointments because it allows them to get out of the house and increase their opportunities for physical activity.^56,63,64 Moreover, establishing connections with others can reduce the sense of emptiness among the elderly, which is very important for them.^100,101

Additionally, a sense of security is an important consideration for older people using DHTs.^54,102 Some patients consider disease status to be very private information and are reluctant to share it with uninvolved people become more cautious when using the internet, fearing that online access to health information or medical services is prone to cyber fraud, privacy breaches.^48,54,57 Older people worry that it will be difficult for DHTs to cope with health problems in emergency situations, concerns about lack of IT knowledge or difficulty in adapting quickly to newer and upgraded features.^62,70 Some older people may forgo the use of features and services because they are unable to distinguish the authenticity of Internet material.^35,38,45

Our review shows that the majority of studies focused on the use of DHTs for home self-health management by older people with chronic diseases, they have higher acceptance and use of DHTs at home, but more exploration in the community and in healthcare organizations is still needed.^103,104

Limitations

First, target population is older people with chronic diseases, but the distribution characteristics of technology mainly focus on COPD, diabetes, heart failure, and hypertension which may not be applicable to other chronic diseases. Second, DHTs may appear in the title or abstract as a specific technology or device, although we searched multiple databases, some research may still be overlooked. Thirdly, our review only considered research in English, which may result in missing some important studies in other languages.

Conclusion

The global aging trend and rise in chronic diseases highlight the importance of DHTs. Digital health technologies provide essential services, including medical support and services, as well as self-management, which exhibit different distribution characteristics in terms of region, time, and chronic diseases. Facilitators such as experience and interpersonal support, alongside barriers including awareness of competence and technological issues, significantly influence the adoption and effectiveness of DHTs. Despite a growing body of research and increasing usage, particularly in developed countries and for COPD, challenges remain in developing countries and with specific patient. Future studies should focus on addressing concerns about DHTs availability, security, and reliability in older people with chronic diseases. Incorporating feedback from the elderly and personalizing services are essential. Digital health technologies in the community and hospitals have great potential in the future with the full mobilization of positive social factors.

Supplemental Material

sj-docx-1-dhj-10.1177_20552076251348578 - Supplemental material for Current status of older people with chronic diseases adopting digital health technologies: A scoping review

Supplemental material, sj-docx-1-dhj-10.1177_20552076251348578 for Current status of older people with chronic diseases adopting digital health technologies: A scoping review by Chengjin Li, Hansong Wang, Jiajun Yuan, Lili Shi, Yunhao Chen, Zefang Gao, Liebin Zhao and Abilio Oliveira in DIGITAL HEALTH

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sj-docx-2-dhj-10.1177_20552076251348578 - Supplemental material for Current status of older people with chronic diseases adopting digital health technologies: A scoping review

Supplemental material, sj-docx-2-dhj-10.1177_20552076251348578 for Current status of older people with chronic diseases adopting digital health technologies: A scoping review by Chengjin Li, Hansong Wang, Jiajun Yuan, Lili Shi, Yunhao Chen, Zefang Gao, Liebin Zhao and Abilio Oliveira in DIGITAL HEALTH

Supplemental Material

sj-docx-3-dhj-10.1177_20552076251348578 - Supplemental material for Current status of older people with chronic diseases adopting digital health technologies: A scoping review

Supplemental material, sj-docx-3-dhj-10.1177_20552076251348578 for Current status of older people with chronic diseases adopting digital health technologies: A scoping review by Chengjin Li, Hansong Wang, Jiajun Yuan, Lili Shi, Yunhao Chen, Zefang Gao, Liebin Zhao and Abilio Oliveira in DIGITAL HEALTH

Footnotes

Acknowledgments

The authors thank the Shanghai Jiao Tong University School of Medicine Library for guiding us in developing an accurate search strategy.

ORCID iDs

Chengjin Li

Hansong Wang

Jiajun Yuan

Lili Shi

Yunhao Chen

Zefang Gao

Liebin Zhao

Abilio Oliveira

Author contributions

LZ and AO conceived of the scoping review and participated in the design. CL and HW participated in screening literature, coding, and drafting the manuscript. HW, JY, LS, YC and ZG participated in the revision of titles, abstracts, and reviews. All authors have contributed to manuscript refinement.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Natural Science Fund of China under Grant number 72293585; Fundamental Research Funds for the Central Universities under Grant number YG2022QN095; Shanghai Public Health Excellent Talent Project under Grant number GWVI-11.2-YQ58. Shanghai Public Health Excellent Talent Project, National Natural Science Foundation of China, Fundamental Research Funds for the Central Universities (grant number GWVI-11.2-YQ58, 72293585, YG2022QN095).

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Guarantor

LZ and AO.

Supplemental material

Supplemental material for this article is available online.

References

Christensen

Doblhammer

Rau

, et al. Ageing populations: the challenges ahead. Lancet 2009; 374: 1196–1208.

Zhang

Kan

Luo

, et al. The promotion of active aging through older adult education in the context of population aging. Front Public Health 2022; 10: 998710.

Mattison

Canfell

Forrester

, et al. The influence of wearables on health care outcomes in chronic disease: systematic review. J Med Internet Res 2022; 24: e36690.

Reiners

Sturm

Bouw

, et al. Sociodemographic factors influencing the use of ehealth in people with chronic diseases. Int J Environ Res Public Health 2019; 16: 645. doi: https://doi.org/10.3390/ijerph16040645

Forkner-Dunn

. Internet-based patient self-care: the next generation of health care delivery. J Med Internet Res 2003; 5: e8.

Stellefson

Chaney

Barry

, et al. Web 2.0 chronic disease self-management for older adults: a systematic review. J Med Internet Res 2013; 15: 35.

Tistad

Lundell

Wiklund

, et al. Usefulness and relevance of an eHealth tool in supporting the self-management of chronic obstructive pulmonary disease: explorative qualitative study of a cocreative process. JMIR Hum Factors 2018; 5: e10801.

Renzi

Baccolini

Migliara

, et al. The impact of ehealth interventions on the improvement of self-care in chronic patients: an overview of systematic reviews. Life (Basel) 2022; 12: 1253. doi: https://doi.org/10.3390/life12081253

Schulte

Aardoom

Loheide-Niesmann

, et al. Effectiveness of eHealth interventions in improving medication adherence for patients with chronic obstructive pulmonary disease or asthma: systematic review. J Med Internet Res 2021; 23: e29475.

10.

Ndayishimiye

Lopes

Middleton

. A systematic scoping review of digital health technologies during COVID-19: a new normal in primary health care delivery. Health Technol (Berl) 2023; 13: 273–284.

11.

de Souza

de Aguiar

Dos

SLM

, et al. The effectiveness of mobile application for monitoring diabetes mellitus and hypertension in the adult and elderly population: systematic review and meta-analysis. BMC Health Serv Res 2023; 23: 55.

12.

Cao

Kadir

Tang

, et al. Effectiveness of mobile application interventions for stroke survivors: systematic review and meta-analysis. BMC Med Inform Decis Mak 2024; 24: 6.

13.

Mesinovic

Fyfe

Talevski

, et al. Type 2 diabetes Mellitus and sarcopenia as comorbid chronic diseases in older adults: established and emerging treatments and therapies. Diabetes Metab J 2023; 47: 719–742.

14.

Mubarak

Suomi

. Elderly forgotten? Digital exclusion in the information age and the rising grey digital divide. Inquiry 2022; 59: 1438277296.

15.

Jafar

Quick

Rimányi

, et al. Social media and digital inequity: Reducing health inequities by closing the digital divide. Int J Environ Res Public Health 2024; 21: 1420. doi: https://doi.org/10.3390/ijerph21111420

16.

Johannes

SJP

Annalisa

Uwe

, et al. Effects of objective and subjective health literacy on patients’ accurate judgment of health information and decision-making ability: Survey study. J Med Internet Res 2021; 23: e20457.

17.

Soo-Yong

. Current status and future direction of digital health in Korea. Korean J Physiol Pharmacol 2019; 23: 311–315.

18.

Wang

Luan

. Research progress on digital health literacy of older adults: a scoping review. Front Public Health 2022; 10: 906089.

19.

Shi

Zhang

, et al. In the digital age: a systematic literature review of the e-health literacy and influencing factors among Chinese older adults. Z Gesundh Wiss 2023; 31: 679–687. doi: https://doi.org/10.1007/s10389-021-01604-z

20.

Zhang

Leuk

Teo

. Domains, feasibility, effectiveness, cost, and acceptability of telehealth in aging care: scoping review of systematic reviews. Jmir Aging 2023; 6: e40460.

21.

Young

Campolonghi

Ponsonby

, et al. Supporting engagement, adherence, and behavior change in online dietary interventions. J Nutr Educ Behav 2019; 51: 719–739.

22.

Zaman

Khan

Evans

, et al. Exploring barriers to and enablers of the adoption of information and communication technology for the care of older adults with chronic diseases: scoping review. JMIR Aging 2022; 5: e25251.

23.

Shahbazi

Bagherian

Sattari

, et al. The opportunities and challenges of using mobile health in elderly self-care. J Educ Health Promot 2021; 10: 80.

24.

Wang

Yuan

, et al. Current status of older people with chronic diseases adopting digital health technologies: A scoping review. Open Sci Framew 2025.

25.

Moher

Shamseer

Clarke

, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4: 1.

26.

Fleming

Koletsi

Pandis

. Blinded by PRISMA: are systematic reviewers focusing on PRISMA and ignoring other guidelines? PLoS One 2014; 9: e96407.

27.

Bourne

DeVos

North

, et al. Online versus face-to-face pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: randomised controlled trial. BMJ Open 2017; 7: e14580.

28.

Price-Haywood

Harden-Barrios

Ulep

, et al. Ehealth literacy: patient engagement in identifying strategies to encourage use of patient portals among older adults. Popul Health Manag 2017; 20: 486–494.

29.

Kim

Park

Lee

, et al. Self-management of chronic diseases among older Korean adults: an mHealth training, protocol, and feasibility study. JMIR Mhealth Uhealth 2018; 6: e147.

30.

Wildenbos

Jaspers

Schijven

, et al. Mobile health for older adult patients: using an aging barriers framework to classify usability problems. Int J Med Inform 2019; 124: 68–77.

31.

van Middelaar

Beishuizen

Guillemont

, et al. Engaging older people in an internet platform for cardiovascular risk self-management: a qualitative study among Dutch HATICE participants. BMJ Open 2018; 8: e19683.

32.

Kuo

Chen

, et al. Use of photo diary and focus group to explore needs for digital disease management program among community older adults with chronic disease. Health Soc Care Community 2022; 30: 926–936.

33.

Yuan

Zhao

, et al. Acceptability and practicability of self-management for patients with Parkinson's disease based on smartphone applications in China. BMC Med Inform Decis Mak 2020; 20: 83.

34.

Barenfeld

Ali

Wallström

, et al. Becoming more of an insider: a grounded theory study on patients’ experience of a person-centred e-health intervention. PLoS One 2020; 15: e241801.

35.

Doyle

Murphy

Gavin

, et al. A digital platform to support self-management of multiple chronic conditions (ProACT): findings in relation to engagement during a one-year proof-of-concept trial. J Med Internet Res 2021; 23: e22672.

36.

Alwashmi

Fitzpatrick

Davis

, et al. Features of a mobile health intervention to manage chronic obstructive pulmonary disease: a qualitative study. Ther Adv Respir Dis 2020; 14: 1022281212.

37.

Gjestsen

Wiig

Testad

. Health care personnel's perspective on potential electronic health interventions to prevent hospitalizations for older persons receiving community care: qualitative study. J Med Internet Res 2020; 22: e12797.

38.

de Batlle

Massip

Vargiu

, et al. Implementing Mobile health-enabled integrated care for Complex chronic patients: intervention effectiveness and cost-effectiveness study. JMIR Mhealth Uhealth 2021; 9: e22135.

39.

Alwashmi

Fitzpatrick

Farrell

, et al. Perceptions of patients regarding Mobile health interventions for the management of chronic obstructive pulmonary disease: mixed methods study. JMIR Mhealth Uhealth 2020; 8: e17409.

40.

Herrmann

Boehme

Hansen

, et al. Digital competencies and attitudes toward digital adherence solutions among elderly patients treated with novel anticoagulants: qualitative study. J Med Internet Res 2020; 22: e13077.

41.

Chairuengjitjaras

Nimmanterdwong

Petchlorlian

, et al. Exploring the feasibility and acceptability of a telehealth platform for older adults with noncommunicable diseases and chronic viral hepatitis. Telemed J E Health 2024; 31: 344–353.

42.

Zheng

Bergh

Murali

, et al. Using mHealth to improve communication in adult day services around the needs of people with dementia: mixed methods assessment of acceptability and feasibility. JMIR Form Res 2024; 8: e49492.

43.

Chien

. Mobile app for patients with chronic obstructive pulmonary diseases during home-based exercise care: usability study. JMIR Hum Factors 2024; 11: e60049.

44.

Quach

Benoit

Packham

, et al. Public mobile chronic obstructive pulmonary disease applications for self-management: patients and healthcare professionals’ perspectives. Health Informatics J 2024; 30: 1217777582.

45.

Lee

Kang

, et al. Preparedness, challenges, and opportunities for digital intervention for chronic disease management: a qualitative study in rural areas of South Korea. Health Syst Reform 2024; 10: 2378503.

46.

Zainal

Hui

Thumboo

, et al. Patients’ expectations of doctors’ clinical competencies in the digital health care era: qualitative semistructured interview study among patients. JMIR Hum Factors 2024; 11: e51972.

47.

Cotter

Shah

Brown

, et al. Decoding the influence of eHealth on autonomy, competence, and relatedness in older adults: qualitative analysis of self-determination through the motivational technology model. JMIR Aging 2024; 7: e56923.

48.

Andrew

Samir

, et al. Exploring the perspectives and experiences of older adults with asthma and chronic obstructive pulmonary disease toward Mobile health: qualitative study. J Med Internet Res 2023; 25: e45955.

49.

Yuyu

Jing

Pingping

, et al. Factors associated with the e-health literacy among older adults with chronic obstructive pulmonary disease: A cross-sectional study. Telemed J E Health 2023; 30: e1138–e1147.

50.

Urban

. ‘This really takes it out of you!’ the senses and emotions in digital health practices of the elderly. Digit Health 2017; 3: 1342056338.

51.

Luo

Zhang

Huang

, et al. From acceptance to dependence: exploring influences of smart healthcare on continuous use intention of mobile health services among older adults with chronic illnesses in China. Behav Sci (Basel) 2024; 15: 19.

52.

Tanaka

Ishii

Matsuoka

, et al. Perspectives of Japanese elders and their healthcare providers on use of wearable technology to monitor their health at home: a qualitative exploration. Int J Nurs Stud 2024; 152: 104691.

53.

Sien

Kobekyaa

Puts

, et al. Tailored self-management app to support older adults with cancer and multimorbidity: development and usability testing. JMIR Aging 2024; 7: e53163.

54.

Liljeroos

. Implementation of telemonitoring in health care: facilitators and barriers for using eHealth for older adults with chronic conditions. Risk Manag Healthc Policy 2023; 2023: 43–53.

55.

Marva

Wei

Lisa

, et al. Preferences of older adult veterans with heart failure for engaging with mobile health technology to support self-care: qualitative interview study among patients with heart failure and content analysis. JMIR Form Res 2022; 6: e41317.

56.

Hofstede

de Bie

van Wijngaarden

, et al. Knowledge, use and attitude toward eHealth among patients with chronic lung diseases. Int J Med Inform 2014; 83: 967–974.

57.

Nymberg

Bolmsjö

Wolff

, et al. ‘Having to learn this so late in our lives…’ Swedish elderly patients’ beliefs, experiences, attitudes and expectations of e-health in primary health care. Scand J Prim Health Care 2019; 37: 41–52.

58.

Alwashmi

Fitzpatrick

Davis

, et al. Perceptions of health care providers regarding a mobile health intervention to manage chronic obstructive pulmonary disease: qualitative study. JMIR Mhealth Uhealth 2019; 7: e13950.

59.

Portz

Bayliss

Bull

, et al. Using the technology acceptance model to explore user experience, intent to use, and use behavior of a patient portal among older adults with multiple chronic conditions: descriptive qualitative study. J Med Internet Res 2019; 21: e11604.

60.

Vergouw

Smits-Pelser

Kars

, et al. Needs, barriers and facilitators of older adults towards eHealth in general practice: a qualitative study. Prim Health Care Res Dev 2020; 21: 54.

61.

Lundell

Modig

Holmner

, et al. Perceptions of home telemonitoring use among patients with chronic obstructive pulmonary disease: qualitative study. Jmir Mhealth Uhealth 2020; 8: e16343.

62.

Hurmuz

MZM

Jansen-Kosterink

Beinema

, et al. Evaluation of a virtual coaching system eHealth intervention: A mixed methods observational cohort study in The Netherlands. Internet Interv 2022; 27. doi: https://doi.org/10.1016/j.invent.2022;27:100501

63.

Jiang

Sun

Chen

, et al. Patients’ and healthcare providers’ perceptions and experiences of telehealth use and online health information use in chronic disease management for older patients with chronic obstructive pulmonary disease: a qualitative study. BMC Geriatr 2022; 22: 9.

64.

Andreou

Dhand

Vassilev

, et al. Understanding online and offline social networks in illness management of older patients with asthma and chronic obstructive pulmonary disease: mixed methods study using quantitative social network assessment and qualitative analysis. JMIR Form Res 2022; 6: e35244.

65.

Marie

HFH

Lunde

HAM

Harald

, et al. Older Adults’ experiences with participation and eHealth in care coordination: qualitative interview study in a primary care setting. J Particip Med 2023; 15: e47550.

66.

Townsend

Leese

Adam

, et al. Ehealth, participatory medicine, and ethical care: a focus group study of patients’ and health care providers’ use of health-related internet information. J Med Internet Res 2015; 17: e155.

67.

Pludwinski

Ahmad

Wayne

, et al. Participant experiences in a smartphone-based health coaching intervention for type 2 diabetes: a qualitative inquiry. J Telemed Telecare 2016; 22: 172–178.

68.

Cao

Liu

, et al. Factors associated with internet use and health information technology use among older people with multi-morbidity in the United States: findings from the national health interview survey 2018. BMC Geriatr 2022; 22: 33.

69.

Chen

Yuan

Shi

, et al. Understanding the role of technology anxiety in the adoption of digital health technologies (DHTs) by older adults with chronic diseases in Shanghai: an extension of the Unified Theory of Acceptance and Use of Technology (UTAUT) model. Healthcare (Basel) 2024; 12: 1421.

70.

Huygens

Vermeulen

Swinkels

, et al. Expectations and needs of patients with a chronic disease toward self-management and eHealth for self-management purposes. BMC Health Serv Res 2016; 16: 32.

71.

Hoque

Sorwar

. Understanding factors influencing the adoption of mHealth by the elderly: an extension of the UTAUT model. Int J Med Inform 2017; 101: 75–84.

72.

Bird

Özer-Erdogdu

Aslan

, et al. Healthcare provider perspectives on digital and interprofessional medication management in chronically ill older adults of Turkish descent in Germany: a qualitative structuring content analysis. Front Public Health 2022; 10: 838427.

73.

Hardinge

Rutter

Velardo

, et al. Using a mobile health application to support self-management in chronic obstructive pulmonary disease: a six-month cohort study. BMC Med Inform Decis Mak 2015; 15: 46.

74.

Gunasekeran

Tseng

Tham

, et al. Applications of digital health for public health responses to COVID-19: a systematic scoping review of artificial intelligence, telehealth and related technologies. NPJ Digit Med 2021; 4: 40.

75.

Rani

Kumar

Mishra

, et al. Digital health: a panacea in COVID-19 crisis. J Family Med Prim Care 2021; 10: 62–65.

76.

Huang

Chen

Yang

, et al. Advancing healthcare accessibility: fusing artificial intelligence with flexible sensing to forge digital health innovations. BME Front 2024; 5: 62.

77.

Piotrowicz

. The management of patients with chronic heart failure: the growing role of e-health. Expert Rev Med Devices 2017; 14: 271–277.

78.

James

Kennedy

Vassilev

, et al. Mediating engagement in a social network intervention for people living with a long-term condition: a qualitative study of the role of facilitation. Health Expect 2020; 23: 681–690.

79.

Kampmeijer

Pavlova

Tambor

, et al. The use of e-health and m-health tools in health promotion and primary prevention among older adults: a systematic literature review. BMC Health Serv Res 2016; 16: 90.

80.

Choukou

Olatoye

Urbanowski

, et al. Digital health technology to support health care professionals and family caregivers caring for patients with cognitive impairment: scoping review. JMIR Ment Health 2023; 10: e40330.

81.

Kong

Hong

, et al. The application and prospect of mobile health (mHealth) in health service for older people living alone in community: a narrative review. Iran J Public Health 2022; 51: 724–732.

82.

NKS

Bahaadinbeigy

Deldar

, et al. Digital health solutions to control the COVID-19 pandemic in countries with high disease prevalence: literature review. J Med Internet Res 2021; 23: e19473.

83.

Ashraf

Gallant

Bradley

. Digital health interventions in older adult populations living with chronic disease in high-income countries: protocol for a scoping review. JMIR Res Protoc 2024; 13: e49130.

84.

Henson

Chapman

Shepherd

, et al. How older indigenous women living in high-income countries use digital health technology: systematic review. J Med Internet Res 2023; 25: e41984.

85.

Boima

Doku

Agyekum

, et al. Effectiveness of digital health interventions on blood pressure control, lifestyle behaviours and adherence to medication in patients with hypertension in low-income and middle-income countries: a systematic review and meta-analysis of randomised controlled trials. EClinicalMedicine 2024; 69: 102432.

86.

Walle

Ferede

Shibabaw

, et al. Willingness of diabetes mellitus patients to use mHealth applications and its associated factors for self-care management in a low-income country: an input for digital health implementation. BMJ Health Care Inform 2023; 30: e100761. doi: https://doi.org/10.1136/bmjhci-2023-100761

87.

López-Campos

Tan

Soriano

. Global burden of COPD. Respirology 2016; 21: 14–23.

88.

Higham

Mathioudakis

Vestbo

, et al. COVID-19 and COPD: a narrative review of the basic science and clinical outcomes. Eur Respir Rev 2020; 29: 200199. doi: https://doi.org/10.1183/16000617.0199-2020

89.

Hallensleben

van Luenen

Rolink

, et al. Ehealth for people with COPD in The Netherlands: a scoping review. Int J Chron Obstruct Pulmon Dis 2019; 14: 1681–1690.

90.

Lundell

Holmner

Rehn

, et al. Telehealthcare in COPD: a systematic review and meta-analysis on physical outcomes and dyspnea. Respir Med 2015; 109: 11–26.

91.

Hanlon

Daines

Campbell

, et al. Telehealth interventions to support self-management of long-term conditions: a systematic metareview of diabetes, heart failure, asthma, chronic obstructive pulmonary disease, and cancer. J Med Internet Res 2017; 19: e172.

92.

Sul

Lyu

Park

. Effectiveness of telemonitoring versus usual care for chronic obstructive pulmonary disease: a systematic review and meta-analysis. J Telemed Telecare 2020; 26: 189–199.

93.

Bitar

Alismail

. The role of eHealth, telehealth, and telemedicine for chronic disease patients during COVID-19 pandemic: a rapid systematic review. Digit Health 2021; 7: 569653108.

94.

Goyal

Cafazzo

. Mobile phone health apps for diabetes management: current evidence and future developments. QJM 2013; 106: 1067–1069.

95.

Contreras

Doubova

Grajales

ÁR

, et al. Design and evaluation of a digital health intervention with proactive follow-up by nurses to improve healthcare and outcomes for patients with breast cancer in Mexico: protocol for a randomised clinical trial. BMJ Open 2023; 13: e77322.

96.

Yang

Shen

Tong

, et al. The impact of digital literacy in enhancing individuals’ health in China. BMC Public Health 2025; 25: 64.

97.

Shao

Gao

. The impact of digital literacy on the health behavior of rural older adults: evidence from China. BMC Public Health 2025; 25: 19.

98.

Lee

. Analysis of the impact of digital literacy on life satisfaction (2019-2022) for older adults in South Korea: a national community-based panel study. Sci Rep 2024; 14: 20399.

99.

Wegener

Bergschöld

Whitmore

, et al. Involving older people with frailty or impairment in the design process of digital health technologies to enable aging in place: scoping review. JMIR Hum Factors 2023; 10: e37785.

100.

Hwang

Kim

Lee

, et al. Loneliness, social isolation, and digital health literacy among older women living alone in South Korea during the COVID-19 pandemic. Psychiatry Investig 2025; 22: 75–83.

101.

Wegener

Bergschöld

Bergh

, et al. Considerations when designing inclusive digital health solutions for older adults living with frailty or impairments. JMIR Form Res 2024; 8: e63832.

102.

Kissi

Azakpah

Mensah

, et al. Healthcare professionals’ perception on emergence of security threat using digital health technologies in healthcare delivery. Digit Health 2024; 10: 599904097.

103.

Ausserhofer

Piccoliori

Engl

, et al. Community-dwelling older adults’ readiness for adopting digital health technologies: cross-sectional survey study. JMIR Form Res 2024; 8: e54120.

104.

Zamantakis

Zapata

Greenawalt

, et al. Barriers and facilitators to implementing keep it up!, A digital health intervention, in community-based organizations. Aids Behav 2024; 28: 3944–3955. doi: https://doi.org/10.1007/s10461-024-04525-6

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