Telehealth as a Sociotechnical System: A Systems Analysis of Adoption and Efficacy Among Older Adults Post-COVID-19

Framed within the lens of systems theory and sociotechnical systems thinking, this systematic review examines telehealth as a complex adaptive system and dynamic health system shaped by the interactions between interconnected technological, social, and institutional components. Recognizing telehealth as part of a complex adaptive system, the review identifies how interdependent factors, such as digital literacy, connectivity, and policy, evolve and influence access to and the emergent properties of care. A systematic review was conducted following the PRISMA 2020 guidelines and PROSPERO registration (CRD420251103608), analyzing 42 peer-reviewed articles published between January 2020 and June 2025, identified through the MEDLINE, Web of Science, EBSCOhost, ACM Digital Library, PsycINFO, and Scopus databases. Key findings include sustained but reduced telehealth use after the pandemic peak, as well as a small yet statistically significant positive effect of telehealth interventions on cognitive emergent properties, defined here as measurable outcomes like memory, attention, executive function, and processing speed (SMD = 0.29; 95% CI [0.04, 0.54]) with very low heterogeneity (I2 = 0%). Significant system components such as digital illiteracy, poor internet connectivity, and complex technology interfaces disproportionately affected economically disadvantaged, minority, and rural older adults. Practical strategies rooted in systems thinking include digital literacy programs, simplified interfaces, caregiver support, improved broadband infrastructure, hybrid healthcare models, and supportive policies. Future research should focus on evidence-based, system-level interventions across diverse settings to bridge the digital divide and promote equitable access to telehealth for older adults.