Bridging the digital divide: the association between smart health devices and disability risk among digitally marginalized older adults in China

This study explores the association of smart health devices on the risk of disability among older adults, and the underlying pathways. The study is grounded in three key factors: the reality of China’s rapidly developing ageing process; the popularisation of smart health devices; and the rapid development of the digital economy. This study utilised the CLASS2020 dataset to investigate the association of smart health devices on the risk of disability among older adults. Multiple linear regression was employed to analyse the data, and a robustness test was conducted by shrinking the sample using propensity score matching. This study utilised the Sobel and bootstrap methods to analyse the mediating effect of smart health devices on the risk of incapacitation among older adults. Additionally, it examined the heterogeneity of digital access and literacy in relation to the association of smart health devices on the risk of incapacitation among older adults. The findings of this study indicated that the implementation of smart health devices, as well as the quantity of these devices utilized by older adults, exhibited a negative association on the risk of disability in this demographic. The analysis of mediating pathways suggested that the association between smart health device use and lower disability risk was partially explained by its correlation with higher levels of intergenerational financial and household support, greater exercise frequency, and increased use of rehabilitation therapy. The analysis of moderating effects demonstrated that older adults' comparative health level exerted a negative moderating effect, while recent hospitalization experience exerted a positive moderating effect. The negative association of smart health devices on the risk of disability in older individuals is more pronounced among those without digital access and with limited digital literacy, while its efficacy is diminished among those with digital access and proficient digital literacy. If the observed associations are causal, our findings suggest that the government promote the universalization of smart health devices, further bridge the digital divide among the older adults, and enhance the digital literacy of the older adults through digital education.