The digital divide as a determinant of inequality in later life : a systematic review

Background: the digitalization of healthcare accelerated by COVID-19 has intensified inequalities among older adults with low digital and health literacy. Methods: following PRISMA guidelines, a systematic search of PubMed, Scopus and Web of Science (2020-2024) identified 64 studies meeting PICO-based criteria. Results: limited digital skills, inadequate infrastructure and low health literacy hindered access to telemedicine and reliable information, especially in rural and socioeconomically disadvantaged settings. Interventions such as digital literacy training and intergenerational support showed benefits but limited scalability. Conclusion: the digital divide acts as a structural determinant of health inequality. Integrated strategies combining digital education, infrastructure development and inclusive policies are needed to support equitable digital health access for older adults. [Publisher's text]