Overcoming barriers to healthcare digitalization for older adults in Asia: What holds them back?

Abstract

This commentary focuses on the key barriers to the implementation of digital healthcare among Asian older adults. Key barriers include healthcare digitalization, including inadequate internet access, technological unfamiliarity, physical and cognitive limitations, trust concerns, language barriers, and financial constraints. Potential solutions include government-subsidized Internet access, senior-friendly technology interfaces, digital literacy programs, and stronger privacy regulations. However, successful digital healthcare adoption requires a collaborative approach among governments, healthcare providers, and technology developers to ensure equitable and inclusive access to digital health. Future research should focus on the cultural and economic factors influencing digital healthcare integration to develop region-specific strategies for sustainable implementation.

Keywords

healthcare digitalization health personnel internet accessibility older adults

1. Introduction

Digitalization in healthcare has revolutionized medical services, improving health monitoring, symptom recognition, follow-up care, and medication management. As global healthcare systems increasingly rely on digital solutions, concerns arise regarding older adults to adapt to these advancements.^1,2 According to the World Health Organization (WHO), the number of people aged 60 and older will significantly increase to 2.1 billion by 2050. Asia, by 2050, will be home to estimated 1.3 billion individuals aged 60 and above, representing approximately 25% of the projected global older adult population.³ Within Southeast Asia alone, the proportion of older adults is expected to rise from 14.4% in 2030 to 22.9% by 2050.^4,5 Despite these demographic shifts, many Asian nations struggle with fragmented healthcare systems, poor integration between primary and tertiary care, and inconsistent funding, further complicating digital healthcare adoption among seniors.^5–7 The WHO South-east Asia regional (SEAR) Strategy on Health ageing 2024-2030 serves as a regional framework to fulfil the goals of the Sustainable Development Goals (SDGs) agenda by promoting health aging.⁸ There are seven implementation enablers which act as a vital tool in strengthening the implementation capacity of the strategic priority domains, of which E.6 (digital technologies) is identified as a key enabler supporting the strategic priorities set out by the WHO SEAR strategy in building an age-friendly environment and supporting long-term care.⁸ The framework is applied by integrating digital technologies to provide simplified regimens for older adults, addressing barriers through both high-tech data management and low-stakes social engagement. The framework also explains how digital technologies can act as a potent tool for integrating large volumes of data, thus sharing it with the healthcare providers and social care systems, empowering electronic health records (EHRs) along with supportive activities such as self-care, entertainment, recreational activities, and learning, thus supporting growth and overcoming loneliness.^8,9 However, older adults worldwide face challenges in embracing digitalization in healthcare due to limited digital literacy, accessibility issues, physical limitations, and trust concerns. The literatures further indicates that digital health adoption is shaped by a range of context-specific factors, including cultural norms, socioeconomic conditions, technological innovation readiness, privacy concerns, and infrastructure availability.^10–12 It is important to note that “Asia” encompasses a highly heterogeneous range of countries and sub-regions that differ markedly in terms of digital infrastructure, healthcare system maturity, economic development, cultural values, and language diversity. The evidence cited in this commentary primarily comes from Southeast and East Asia, and the findings may not be uniformly applicable across the continent. This diversity is acknowledged throughout the discussion and should be considered when interpreting the barriers and recommendations presented. Given the challenges to digital healthcare adoption observed across parts of Asia, this commentary examines the key barriers to older adults’ engagement with digital health tools and explores potential strategies and recommendations to facilitate their adoption (Figure 1).

Figure 1.

Barriers and recommendation for digital healthcare among aging population.

2. Literature search strategy

This commentary adopts a narrative review to synthesize existing evidence on barriers to digitalization of healthcare among older adults in Asia. A literature search was conducted across PubMed, Scopus, Web of Science, and Google Scholar, covering publications from 2013 to 2025, using Boolean combinations of terms such as “healthcare digitalization,” “digital health,” “older adults,” “elderly,” “aging population,” “Asia,” “barriers,” “internet accessibility,” “digital literacy,” and “technology adoption.” The search was restricted to English-language publications.

Studies were selected based on the following criteria: (1) focused on barriers or facilitators of digital healthcare adoption among adults aged 60 years and above; (2) conducted in or drew evidence from Asian countries or regions; and (3) comprised original research articles, systematic or narrative reviews, or policy-relevant commentaries. Studies were excluded if they focused exclusively on non-Asian populations, did not address the older adult demographic, or lacked a clear empirical or analytical basis. Titles and abstracts were screened by the authors for relevance, followed by a full-text review of eligible sources. The included literature was thematically organized around recurring barriers, including inadequate internet access, technological unfamiliarity, physical and cognitive limitations, trust concerns, language barriers, and financial constraints, along with proposed solutions. As this is a narrative commentary, the synthesis reflects the authors’ interpretive judgment rather than a formal systematic review protocol; findings should therefore be understood as an evidence-informed overview rather than a comprehensive or exhaustive account.

3. Key barriers to digital healthcare adoption

3.1. Accessibility to the internet

Limited internet access remains a significant challenge. Socioeconomic disparities impact internet accessibility in Asia, particularly in rural and low-income communities.¹³ Many older adults lack broadband internet access due to high costs, infrastructure limitations, and limited exposure to digital technology.^14–16 Poor connectivity reduces familiarity with digital tools, discouraging seniors from incorporating them into their healthcare routines.^14,16 This underscores the need for governments to expand broadband infrastructure and provide subsidized or free internet access for seniors. Additionally, telecommunication providers could offer affordable senior-specific mobile data plans. In Malaysia, the Ministry of Communications has taken a step forward in recognizing the needs of underprivileged groups and senior citizens by providing subsidized internet packages.¹⁷ In a recent initiative, the government launched the Fixed Internet Broadband Unity Package to offer affordable broadband access to B40 (Bottom 40% of the population) households, senior citizens, persons with disabilities, and veterans.¹⁷ More broadly, policies should ensure free Wi-Fi access in healthcare facilities and community centers, enabling older adults to use digital health tools without incurring a financial burden.

3.2. Low digital literacy and a lack of familiarity with technology

Low digital literacy and a lack of familiarity with technology create further obstacles.^18,19 Digital literacy is defined as the ability to use or communicate through technology-based content. Many older adults struggle to navigate digital health platforms, including EHRs, online appointment systems, and mobile health applications. A study by Nugroho et al. (2022) found that seniors in Asia face difficulties accessing digital health resources due to a lack of guidance and digital literacy.²⁰ Similarly, a study by Bertolazzi et al. (2024) found that seniors with chronic diseases face difficulties in adopting health technologies due to low self-efficacy and limited knowledge.²¹ These difficulties arise primarily from low digital literacy and the scarcity of pertinent information and guidance. Healthcare professionals should actively educate seniors on using digital health tools through one-on-one training and guided demonstrations. This can be achieved by training and deploying healthcare personnel to support individuals who need assistance on digital health adaptations. Governments should establish 24/7 digital health support helplines to assist older adults with digital healthcare platforms. Community-based workshops and senior-friendly digital training programs should prioritize hands-on learning over complex written manuals.

3.3. Physical limitations and age-related decline

Physical limitations and age-related decline also hinder adoption. Aging is associated with declines in vision, hearing, and cognitive function, making digital interfaces difficult to navigate.^22,23 Providing interactive services that consider older adults’ vision and hearing, rather than passive, one-way information delivery, will improve the adoption of technology among older adults.²⁴ Digital healthcare tools should adopt age-friendly designs, such as larger fonts and high-contrast color schemes, voice-assisted navigation, and simplified user interfaces.²⁵ Examples include integrating simple terms such as ‘done’, ‘complete’, and ‘finish’ to indicate task completion when entering or saving information, thereby reducing user confusion.²⁶ Adaptive technologies should be incorporated for individuals with vision and hearing impairments. While drawn from a different regional context, Finland’s approach offers a transferable model that incorporates assistive technology for visually impaired hospital patients, focusing on electro-optical aids that merge digital electronics with optics.²⁷ Similarly, wearable health devices should include a single-touch feature rather than requiring app-based interactions.

3.4. Lack of trust in digital healthcare

Lack of trust in digital healthcare presents another major barrier.²⁵ Privacy concerns, fears of online scams, and skepticism toward digital health technologies prevent older adults from engaging with digital healthcare.^28–31 Devices such as fall-risk sensors and remote monitoring tools require personal data input, which many seniors perceive as an invasion of privacy.²⁹ Moreover, scams and misinformation spread through social media further fuel distrust of online healthcare services.^32,33 To prevent such issues, governments must be committed to introducing stronger data protection laws to reassure older adults about privacy and security. Public awareness campaigns should also help in educating seniors about safe digital practices, including recognizing scams and using verified healthcare platforms. Government-backed digital health programs should carry official certifications and digital security education to ensure trust and credibility among older users.³⁴

3.5. Financial barriers

Financial barriers beyond internet costs further complicate the adoption of digital healthcare.¹⁸ While internet access remains a primary concern, without the necessary economic support for sufficient tools and resources, this barrier prevents purchasing digital tools such as smartphones with broadband coverage. The cost of digital devices such as smartphones, tablets, and wearables poses another significant financial hurdle.³⁵ Many seniors live on fixed incomes, making it difficult to afford the necessary technology for digital healthcare. Governments should offer subsidies or financial assistance to help low-income seniors afford digital health devices. Tech companies should develop affordable and age-appropriate healthcare wearables. Public-private partnerships could offer affordable leasing programs for health-monitoring devices.

3.6. Language and literacy barriers

Language and literacy barriers also limit the adoption of digital healthcare.³⁶ Many digital health applications are available only in English or dominant regional languages, excluding non-native speakers and those with low literacy levels.³⁷ Some older adults who are otherwise digitally competent may still face language barriers. Developers can create multilingual healthcare apps with voice-command features. Icon-based navigation should replace text-heavy interfaces for those with limited literacy. The government could support the development of such tools or apps by addressing language and literacy barriers through grant or incentive programs that evaluate feasibility and impact.

3.7. Mental and emotional barriers

Mental and emotional barriers contribute to resistance against digital healthcare.³⁸ Many older adults are uncomfortable with technology and believe that it benefits the healthcare professionals by making their jobs easier.²² Reflecting these preferences, healthcare services should be delivered within a framework that respects the conventional care practices familiar to the older adults.³⁹ Anxiety about making mistakes or reliance on unfamiliar technology further discourages engagement.⁴⁰ While these emotional and attitudinal barriers share some surface features with trust-related concerns, they are conceptually distinct: trust barriers relate primarily to external perceptions of technology risk and data security, whereas mental and emotional barriers arise from internalized self-doubt and psychological resistance. Interventions should therefore address these separately. Hybrid healthcare models that preserve in-person consultation options can reduce the psychological pressure associated with mandatory digital engagement. Peer support networks and group-based digital orientation sessions, led by community health workers or trained volunteers, are particularly suited to alleviating technology anxiety without conflating this goal with formal digital literacy training.

4. Discussion: A path forward to overcoming digital health barriers in the aging population

This commentary examines the substantial barriers to digitalization in healthcare that persist among the geriatric population in Asia, particularly in accessing and using digital health technologies. Despite the growth of telehealth and digital health in the post-pandemic era, many older adults have difficulty engaging with these technologies due to low trust in technology, low digital literacy, age-related cognitive impairment, and limited resources.

The barriers identified in this review can be understood through the lens of digital divide theory, which conceptualizes inequalities in technology adoption as occurring across multiple levels. Van Dijk’s model, for instance, distinguishes between motivational access, material access, skills access, and usage access, each representing a progressively deeper layer of digital engagement.^41,42 Applying this framework to the Asian context allows for a more structured understanding of how digital exclusion manifests among the older adult population and moves the analysis beyond descriptive categorization toward a theoretically grounded interpretation. This perspective is further supported by Hargittai (2002), who highlighted skills-based inequalities as a “second-level digital divide,”⁴³ and Warschauer (2003), who argued that meaningful access to technology requires not only physical infrastructure but also social, cultural, and educational resources.⁴⁴

Specifically, the barriers identified in this commentary can be classified along three dimensions. Structural barriers include limited internet infrastructure, affordability constraints, and inadequate availability of digital devices in rural settings. Capability-based barriers encompass low digital literacy, cognitive decline associated with aging, and insufficient training opportunities tailored to older adults. Attitudinal barriers include low trust in technology, fear of privacy breaches, and a strong cultural preference for face-to-face consultations with healthcare providers. This tripartite distinction aligns with broader digital exclusion frameworks^45,46 facilitating the design of targeted, specific interventions.

Importantly, these barriers do not function independently but interact in ways that compound digital exclusion among the older adult population.⁴⁷ For instance, limited infrastructure restricts exposure to technology, which in turn prevents the development of digital skills, further reinforcing low confidence and distrust toward digital health platforms. In Asian settings, this interaction is intensified by cultural norms that prioritize in-person care and family-mediated health decisions, creating a self-reinforcing cycle of digital disengagement. Research has shown that digital exclusion in older adults is a complex, multi-causal phenomenon in which sociodemographic, physiological, and psychological factors interact to produce compounding effects.^46,48 Addressing any single barrier in isolation is therefore unlikely to produce sustainable improvements in digital health adoption, and interventions must target multiple levels simultaneously to break this cycle.⁴²

Addressing these barriers requires collaboration between healthcare providers, governments, and technology developers. Although similar challenges are encountered in Western countries, the Asian context presents unique complexities arising from linguistic diversity, family-centered care norms, and uneven digital infrastructure that require tailored solutions.^25,49 Digital health literacy differs across Asian and Western regions due to varying economic development, social and family support, cultural values, and trust in emerging technologies. As digital health development in Asia is still in its early stages compared to Western counterparts, a framework to address the identified barriers highlighted in previous studies should be developed. In addition, limited studies have been conducted on digital health literacy interventions in this region.⁵⁰

Existing research confirms that various sociodemographic factors, such as literacy level, age, and location, significantly contribute to digital engagement among the older adult population.^51,52 Although various initiatives have been attempted to address those issues, such as smartphone training programs and community access centers, many of these programs remain unable to tailor their approaches to the older adult population, particularly in rural settings.³⁸

Given the many challenges to adopting technology among the older adult population, it is important to address each of them through the conceptual lens outlined above. Studies have shown that digital tools for older adults should be user-friendly, simple, and culturally appropriate, as these design considerations directly address both capability-based and attitudinal barriers by reducing complexity and building user confidence.^39,40 Crucially, digital literacy programs targeting capability-based barriers differ in intent from trust-building initiatives addressing attitudinal barriers: the former aim to build functional competence, while the latter seek to foster confidence and psychological readiness. Both dimensions must be addressed concurrently, as low literacy can reinforce distrust, and vice versa; conflating them in a single intervention risks diluting effectiveness. Programs should therefore be structured to first build basic digital skills before progressing to components addressing trust and privacy awareness.

The literature also reveals the significant impact of a digital health intervention in frail older patients, as the intervention and literacy were found to improve frailty status, cognitive abilities, health-related quality of life, and grip strength.^53,54 An increase in the number of studies regarding digital health has also significantly increased post-2018 within the Asian context, from countries including Japan, South Korea, China, and Singapore, with a focused approach on smart technologies, wearable devices, mHealth, telemedicine, and Internet of Things (IoT) based systems, as they were found to improve quality of life, help in reducing the risk of falls, and support the care for frail older populations within community and clinical settings.⁵⁵

Given the significant impacts and positive outcomes of these interventions, it is essential that policymakers prioritize digital inclusivity in a structured, sequenced manner. Given that structural barriers represent the most foundational layer of digital exclusion, they should be addressed as a first priority: national governments in lower-income Asian countries should establish time-bound targets for rural broadband coverage and create subsidy schemes specifically for low-income older adults to access devices and data plans, modeled on initiatives such as Malaysia’s Fixed Internet Broadband Unity Package.⁵⁶ As a second priority, capability-based barriers should be systematically addressed by integrating digital health literacy into community health programs and requiring healthcare facilities to provide structured one-on-one device orientation for older patients as part of routine care.⁵⁷ Attitudinal barriers, while equally important, are more effectively addressed once the structural and capability foundations are in place; targeted trust-building through government-endorsed digital health certification schemes and transparent data governance frameworks should therefore be developed as complementary, ongoing efforts. Drawing on the framework presented above, structural barriers should be addressed through investment in rural digital infrastructure and affordable device programs. Capability-based barriers require training health practitioners and digital service designers to better support older adult users in navigating online platforms, thereby reducing digital exclusion and improving overall health equity and outcomes.¹² Attitudinal barriers necessitate governmental involvement in regulating privacy laws to instill trust in digital healthcare. Hybrid healthcare approaches should be maintained to ensure that digital tools do not replace essential human interaction in patient care, particularly in Asian cultural contexts where interpersonal relationships are central to the care experience. Future research should examine the real-world experiences of the older adult population with digital health technologies to inform localized interventions. Studies that explore the systemic interactions among structural, capability-based, and attitudinal barriers in specific rural Asian communities would be particularly valuable for designing comprehensive, context-sensitive solutions. Moreover, it is essential that health policymakers and healthcare providers collaborate to devise and adopt digital health strategies to ensure better healthcare provisions for the older adult population.

5. Conclusion

Digital healthcare adoption among the older adult population in Asia is hindered by interconnected structural, capability-based, and attitudinal barriers that risk excluding a significant portion of the aging population from the benefits of healthcare digitalization. Addressing these challenges demands urgent, coordinated action from governments, healthcare providers, international organizations, and technology developers to create region-specific and culturally grounded digital health strategies rather than adopting one-size-fits-all approaches. Given the unique cultural values, family dynamics, and infrastructure realities across rural Asian communities, digital health interventions must be tailored to local contexts to ensure meaningful and equitable access to healthcare. Future research should prioritize understanding the real-world experiences of older adults with digital health technologies in diverse Asian settings, with particular attention to how cultural attitudes, financial constraints, and systemic barriers interact to shape digital engagement in this population.

Footnotes

ORCID iDs

Christina Malini Christopher

Nabin Pathak

Sunil Shrestha

Authors contributions

Christina Malini: Conceptualization, Methodology, Formal analysis, Visualization, Writing – original draft. Nabin Pathak: Conceptualization, Methodology, Writing – review & editing. Ali Qureshi: Supervision, Conceptualization, Methodology, Writing – review & editing. Maryam Farooqui: Supervision, Methodology, Writing – review & editing. Sunil Shrestha: Supervision, Methodology, Writing – review & editing.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

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

Disclaimer for use of AI

The authors used an artificial intelligence–assisted language tool to support language editing and improve clarity during manuscript preparation. All content was critically reviewed and verified by the authors, who take full responsibility for the accuracy and integrity of the manuscript.

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