Silent Exclusion: An Analysis of the Healthcare Integration Dilemma for the Elderly in Seeking Medical Treatment under Urban Digital Transformation

Concurrent urban digital transformation and population aging have exacerbated the technological adaptation challenges and the "silver digital divide" faced by the elderly in healthcare settings. To deeply analyse its manifestations and underlying mechanisms, this study, based on a qualitative investigation in healthcare settings, constructs and validates a three-dimensional analysis framework for this dilemma: "Inability to use" refers to challenges at the operational and comprehension levels; "unwillingness to use" reveals psychological rejection and crisis of trust; and “lack of access” exposes systematic access barriers. The research finds that the root cause of this dilemma lies in the "elderly digital disability”, an intrinsic condition. This decline in ability due to aging is further magnified and solidified by the combined effects of the exclusionary design of external technologies and the inadequate compensatory support from amily and society. To resolve this issue, it is necessary to go beyond superficial technological fixes and establish a multi-stakeholder collaborative governance system where the government provides top-level design and foundational guarantees, the market deepens "genuinely" elderly-friendly adaptations, and society and families strengthen empowering support, to promote society's transition from "digital governance" to "digital good governance.".