JMIR Publications

ABSTRACT

Background:

Telehealth, broadly defined as the use of telecommunication technologies for remote healthcare, was adopted as a necessary strategy to maintain continuity of care and reduce the risk of infection during the COVID-19 pandemic. Although the rapid adoption of telehealth since the pandemic has increased access to these services, older adults still face unique barriers to effective use. Understanding these barriers and digital-readiness factors is crucial to promoting equitable access to healthcare.

Objective:

This systematic literature review explored the primary barriers to telehealth and digital access among older adults by synthesizing evidence on technological, individual/skills-based, and systemic/structural challenges, as well as facilitators and factors influencing digital readiness.

Methods:

Following the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines, a comprehensive search of the EBSCOhost database identified 1,740 records, along with three additional records from other sources. After removing 1,500 duplicates and irrelevant records, 243 titles and abstracts were screened, 30 full texts were assessed, and 16 studies published between 2022 and 2025 were systematically reviewed. The included studies comprised cross-sectional observational studies (n=4, 25.0%), qualitative studies (n=5, 31.3%), mixed-methods studies (n=2, 12.5%), scoping reviews and meta-syntheses (n=3, 18.8%), and other designs (n=2, 12.5%). Studies were included if they examined barriers to access to telehealth, digital readiness, or related outcomes among adults aged 50 years or older. Data were extracted on study characteristics, barriers, facilitators, and outcomes. A thematic synthesis was conducted across the domains of technological, individual, and systemic barriers.

Results:

The review included 16 studies from various geographic regions, mainly from the United States and other high-income countries. All 16 studies identified barriers in three categories: technological barriers (internet connectivity, device access, platform usability), individual or skill-based barriers (low digital literacy, cognitive and sensory impairments, technology anxiety), and systemic or structural barriers (lack of training and support, inadequate infrastructure, language barriers). Key facilitators included prior technology experience, family support, and hybrid care models. Digital readiness varied across education, socioeconomic status, and prior technology exposure.

Conclusions:

Older adults encounter interconnected technological, individual, and systemic barriers to telehealth access. Overcoming these challenges requires multilayered strategies, including investing in infrastructure, providing tailored digital literacy training, offering ongoing technical support, and adopting person-centered care models. Future studies should prioritize equity-focused solutions for the most vulnerable older adult groups.