Digital exclusion and health in older adults: a systematic review

Abstract Healthcare systems are turning increasingly digital. Digital exclusion restricts access to a wider range of health-related resources among older adults, which delays prevention and treatment, posing additional health challenges. The study aims to systematically review the published evidence on digital exclusion and its implications for health outcomes among older adults. We conducted a systematic review following PRISMA guidelines (PROSPERO#CRD420250655824), searching five databases and major institutional sources up to March 2025 to identify studies linking digital exclusion to health outcomes in adults aged ≥60, with explicit consideration of socioeconomic determinants. Our findings indicate that digital exclusion among older adults is associated with the convergence of socioeconomic disadvantage, health-related vulnerabilities, and contextual barriers across three levels of the digital divide. These contribute to a poorer quality of life and adverse health outcomes in later life. Digital exclusion is therefore not merely a technological challenge, but a manifestation of structural inequities that requires coordinated, system-level responses, including affordable access, digital skills support, age-friendly service design, and non-digital alternatives for those who remain excluded.