Age-friendly healthcare needs better digital design as older adults face usability gaps

Information and communication technologies (ICTs) are increasingly being used to support age-friendly healthcare, but poor age-centered design, privacy risks, fragmented systems and uneven access for older adults limits their impact, claims a new study published in Information.

The study, titled Exploring the Application of Information and Communication Technologies in Age-Friendly Healthcare: A Systematic Scoping Review, maps how ICT tools are being designed, deployed and evaluated in healthcare for older adults, covering applications such as electronic health records, telemedicine, artificial intelligence systems, smart homes, mobile health tools and integrated digital health platforms.

Digital health tools move into elderly care as health systems face aging pressure

Healthcare systems are facing mounting pressure from population aging, rising care costs, chronic disease burdens and shortages in clinical resources. Older adults often need continuous care, medication safety checks, chronic disease management, cognitive support, rehabilitation and help navigating health information. Traditional models built around in-person registration, hospital visits and fragmented records are increasingly unable to meet those needs.

ICT, technologies used to collect, process, store, manage and exchange electronic information, including digital platforms, health information systems, artificial intelligence tools, electronic records, telehealth systems, smart home devices and mobile applications, is a key driver of age-friendly healthcare. In older-adult care, these tools can support clinical decision-making, healthcare service delivery, patient self-management and communication between care providers.

The review links these technologies to the broader age-friendly health system agenda, including care models that focus on what matters to older adults, medication safety, mentation and mobility. ICT can support these priorities by documenting patient goals, flagging medication risks, tracking cognitive changes, monitoring mobility and enabling care coordination across settings.

The authors conducted a systematic scoping review following PRISMA-ScR guidelines. They searched Web of Science, Scopus, PubMed, ScienceDirect and IEEE Xplore for studies published from January 2020 to November 2025, with backward citation chaining used to strengthen the search. From 1,310 records, 16 empirical studies met the final inclusion criteria. The strict selection focused on original journal articles that examined ICT applications in age-friendly healthcare and reported measurable implementation results.

The included studies covered seven countries and regions: China, South Korea, the United States, Germany, Japan, Italy and Nigeria. China accounted for the largest number of studies, followed by South Korea and the United States. The authors say research activity increased after 2023, reflecting growing interest in smart elderly care, digital health and technology-enabled healthcare support for aging populations.

The review's evidence base is limited in size, but the authors argue it is representative of the major application areas now shaping age-friendly digital healthcare. The included studies covered smart home and home-based health management, integrated medical systems and care optimization, AI-assisted applications, health information management and mobile health, telehealth and video health services, and smart medical products combined with multi-ICT platforms.

Smart homes, AI assistants and EHRs reshape care delivery for older adults

The review identifies smart home and home-based health management as the most widely studied application area. These systems use tools such as home monitoring sensors, cognitive assistive products, wearable sensors and interactive smart home platforms to support independent living, safety monitoring, health reminders, emotional support and family connection. Their goal is to help older adults remain at home longer while giving caregivers and health providers better information about daily activity and health risks.

Smart home technologies were especially linked to aging in place. In the reviewed evidence, they supported emergency alerts, daily activity monitoring, fall-related safety functions, home-based health management and social connection. Some interactive systems also attempted to address emotional well-being through feedback, companionship functions and community integration. The authors note that these systems may improve quality of life and independence, but adoption is affected by usability, cost, infrastructure and privacy concerns.

AI-assisted applications formed another major category. These included AI virtual assistants, GPT-based virtual human devices and AI-supported health information simplification models. Their uses ranged from helping older adults understand complex medical information to offering companionship and assisting with delirium prevention in hospitalized patients.

The review shows that AI tools can lower barriers to health communication, especially for older adults with low health literacy or mild chronic conditions. AI-based systems can simplify medical explanations, provide reminders, support emotional interaction and help clinical teams monitor risks. In hospital settings, AI virtual assistants have been explored for non-intrusive support in delirium prevention and management. The authors caution, however, that clinical effectiveness, privacy protections and ease of independent use still require stronger evidence.

Electronic health record systems and integrated ICT service platforms were also central to age-friendly care. These systems can standardize patient information, support care workflows, improve medication safety and connect data across institutions. In long-term care settings, integrated platforms were linked to improved chronic disease management, safer medication practices and algorithm-supported guidance for healthcare staff.

Telehealth and video health services were used to support remote consultation, geriatric assessment, post-discharge follow-up and care coordination. These tools are especially relevant for high-risk older adults who return home after emergency department care, as they can reduce travel burden and allow providers to identify unmet needs more quickly. The review notes that long-term effectiveness, coverage and cost-effectiveness remain uncertain.

Mobile health and personal electronic health record systems were also identified as tools for personal health information management, medical record access and health behavior tracking. These systems can increase participation in self-care, but they must be designed around older adults' preferences, including clearer interfaces, simpler navigation and lower cognitive load.

The target populations included healthy older adults, older people in long-term care with chronic diseases, older adults living at home with mild chronic conditions, people with dementia or cognitive impairment, high-risk elderly veterans after emergency department discharge and prefrail older adults. The authors found that different groups require different tools. For example, older adults with chronic illness may benefit from electronic records and integrated care platforms, while people with cognitive impairment may need assistive products and smart home support. Prefrail older adults may benefit from multidomain platforms covering physical activity, cognition, nutrition, sleep and psychosocial support.

Age-centered design, privacy and interoperability remain weak links

ICT deployment in age-friendly healthcare cannot succeed through technical capability alone. The authors propose a Technology Design, Scenario Application and Effect Evaluation framework, grounded in sociotechnical systems theory, to explain how digital health tools should be assessed. The framework links the design of the technology, the care setting in which it is used and the outcomes it produces for users, services and health systems.

Design

At the technology design level, the review finds persistent barriers in usability and accessibility. Many systems remain shaped by design assumptions that fit younger or more digitally confident users. Older adults may face difficulties with device operation, interface complexity, small screens, unclear instructions, unfamiliar workflows or low confidence in digital systems. These barriers are more serious for people with cognitive impairment, physical limitations, low digital literacy or limited support.

The authors argue that age-centered design must become a central requirement, not an afterthought. That means simplified interfaces, personalized functions, emotional support, stronger accessibility features, clear language and designs that reflect older adults' real care routines. Several reviewed studies showed that acceptance improves when technologies are aligned with older adults' emotional, physical and cognitive needs.

Application level

At the scenario application level, the review finds that technology must be matched to the care setting. Smart homes are better suited to home-based care and aging in place. Electronic health records and integrated ICT platforms are more relevant to institutional care and long-term care settings. Telehealth fits transitional care and post-discharge follow-up. Multi-ICT platforms are useful for community-based prevention and frailty management. But many systems remain poorly connected, creating data silos across home care, hospitals, communities and long-term care facilities.

Data interoperability is a major weakness. Older adults often move between care settings, but digital systems may not share information smoothly. That limits continuity of care and weakens the value of ICT-supported monitoring. The authors call for stronger system integration, middleware capable of linking data across institutions and standards that allow information to follow patients securely across different care environments.

Evaluation

At the effect evaluation level, the review finds that most evidence focuses on usability, feasibility and acceptance rather than long-term clinical outcomes or sustained behavior change. Some technologies showed benefits in quality of life, mood, nutrition, medication safety, service efficiency and care coordination. But the evidence remains limited by small samples, heterogeneous methods and short follow-up periods. Only a small number of randomized controlled trials were available, limiting conclusions about clinical impact.

Further, privacy and data security remain major concerns. AI assistants, smart home systems, telehealth platforms and integrated health records can collect sensitive information about older adults' health, behavior, location, medication and daily routines. The review highlights the need for strong data governance, privacy protection and secure system design, especially as older users may not fully understand how their information is collected or shared.

The review also raises equity concerns. Technologies that depend on reliable internet, costly devices or professional installation may widen gaps between older adults in wealthy and low-resource settings. Rural areas, underdeveloped regions and vulnerable groups may be left behind if ICT adoption depends heavily on infrastructure and individual purchasing power. The authors say governments and healthcare systems should support low-cost, easy-to-use digital tools in resource-limited areas while building the infrastructure needed for more advanced systems.

Training is another barrier. Healthcare professionals need digital skills and age-friendly care training to use ICT tools effectively. Older adults also need support to overcome digital literacy gaps. Without training, even well-designed tools may fail in practice.