eHealth and the Digital Divide Among Older Canadians: Insights from a National Cross-Sectional Study.

Background: The multidisciplinary life course theory emphasizes the relation between a person's choices and their socioeconomic context, and their capacity to make decisions within existing opportunities or constraints. Older age is particularly characterized by social and environmental conditions that may impact people's use of technology and eHealth applications. Objective: This research aims to present an overview of eHealth application use among older Canadian adults and examine the relationship between eHealth use and social and health system interaction determinants. Methods: We conducted a national cross-sectional survey of older adults (n=2000) in Canada, assessing their technology (eg, tablets, computers) and eHealth application (eg, fall detection and telemonitoring technologies, internet) use, social determinants (eg, sociodemographic characteristics, environmental living conditions), and health system interactions (eg, health status, access to care, services utilization). Results: There is technological readiness (owned a computer: 1703/2000, 85.2%; used the internet daily or a few times per week: 1652/2000, 82.6%) among older Canadian adults, although it does not translate into eHealth application use. Internet use to connect with health care professionals, access results or patient portals, or book medical appointments was limited. The use of telemonitoring and fall detection technologies was low (189/2000, 9.4%, and 84/2000, 4.2%, respectively). There were significant variations in eHealth use, highlighting the importance of accounting for social determinants and interactions with the health care system. Of the variance in online access to laboratory results, 12.7% was explained by the province of residence (higher in Ontario and British Columbia), living environment (lower in rural settings), and access or need variables (higher for those with private insurance and willingness to pay for quicker access; higher for those hospitalized). Women reported more internet use for self-diagnosis and looking for online information. Individuals with excellent perceived health and those with no recent emergency visits or home care services reported greater use of mobile health apps and fall detection technologies (odds ratio [OR]=2.16, 95% CI 1.23-3.80; OR=3.427, 95% CI 1.55-7.60), respectively. A digital divide exists within the older adult population, which raises concerns about whether those with higher needs and limited resources have access to and can benefit from eHealth applications. Conclusions: Addressing the digital health gap among older adults is not simply a matter of technological access but also a matter of health equity and system sustainability. Without deliberate policies, digital health risks reinforcing existing disparities by disproportionately excluding those with the greatest health needs and the fewest resources. Our findings identify the groups most at risk of digital exclusion, such as rural residents, institutionalized older adults, and those with limited financial or insurance coverage, and point to where interventions can yield the greatest benefit.