Frail older adults' challenges in using telehealth services: A scoping review.

Objective: Telehealth is increasingly used to expand access to healthcare, but rapid digitalization risks exacerbating exclusion among frail older adults, who often face intersecting limitations related to health, resources, and digital competence. As this group frequently has complex care needs, mapping their experiences is essential to ensure equitable access to digital care. The aim was to map the challenges frail older adults experience when using telehealth services. Methods: This scoping review followed Arksey and O'Malley's framework and PRISMA-ScR guidelines. PubMed, CINAHL, Scopus, and Web of Science were searched for peer-reviewed empirical studies published in English (January 2015-June 2026). Studies were included if they addressed relevant challenges from the perspectives of frail older adults or those with multimorbidity, disability, cognitive impairment, or dependency. Data were charted and analyzed narratively. Results: Of 7200 studies identified, 22 were included. All of them used qualitative methods and were conducted in Europe, North America, and Asia; only four applied formal frailty assessments. Five domains were identified: 1) digital accessibility, 2) digital skills, 3) health status, 4) digital support, and 5) financial resources. Conclusions: As frail older adults face multiple, interconnected challenges to telehealth use, including technological and environmental constraints, limited digital competence, health-related impairments, insufficient support, and financial challenges, services should be designed to align with their needs and life circumstances. Accessible design, structured support, affordable connectivity, and active involvement of frail older adults are essential to ensure equitable and inclusive digital healthcare.