The psycho–social dual-pathway perspective on healthy aging in digital age-friendly environments: longitudinal evidence from China

Attitudes toward one’s own aging are closely related to health and well-being in later life. Meanwhile, digitalization during and after the COVID-19 pandemic has changed older adults’ access to services, social participation, and everyday health management. Digital inclusion may support healthy aging, but it may also create burdens when digital use is difficult, stressful, or poorly supported. Yet few studies have examined how aging attitudes and digital inclusion are jointly related to health over time. This study investigated the longitudinal relationships among aging attitudes, digital inclusion, and health among older adults in China. We used two-wave panel data from the China Longitudinal Aging Social Survey (CLASS 2020 and 2023; N = 3,320). Generalized estimating equations were used to estimate adjusted longitudinal associations. Cross-lagged panel models examined temporal and potentially reciprocal relationships, and structural equation modeling tested whether digital inclusion mediated the association between aging attitudes and health. Models adjusted for sociodemographic characteristics, chronic disease, and functional status. Aging attitudes were highly stable over time. In the GEE and SEM analyses, more positive aging attitudes were associated with better health outcomes. However, the cross-lagged models showed a more complex pattern after baseline stability was considered. Digital inclusion also showed mixed associations with health: digital proficiency and digital ability were positively associated with health, whereas digital access alone showed no consistent benefit. Baseline digital inclusion was negatively associated with later health and aging attitudes in the cross-lagged models. Mediation analyses suggested that digital inclusion partially explained the relationship between aging attitudes and health, supporting the coexistence of psychological and digital-social pathways. The findings support a psycho-social perspective on healthy aging. Aging attitudes were generally linked to better health, while digital inclusion showed mixed associations, suggesting that digital engagement can be helpful when it is meaningful and supported, but burdensome when it exceeds older adults’ skills or needs. Policies and interventions should therefore go beyond expanding digital access and strengthen digital competence, age-friendly digital environments, and positive views of aging to support healthier and more inclusive aging.