The Associations Between Digital Exclusion and Physical or Cognitive Function in Middle-Aged and Older Adults: Systematic Review and Meta-Analysis

Clinical Snapshot

Key Findings

• P Value: Statistical significance achieved for most outcomes except frailty and cognitive impairment

• Effect Size: Basic ADL: IRR 1.35 (1.12-1.64); Dementia: HR 1.78 (1.43-2.22); MMSE decline: OR 1.96 (1.39-2.75)

• Primary Outcome: Digital exclusion associated with decreased activities of daily living and cognitive function

• Nnt Or Sensitivity: Hazard ratio 1.78 for dementia represents 78% increased risk with digital exclusion

• Confidence Interval: 95% confidence intervals provided for all pooled estimates

Clinical Application

Findings support digital inclusion initiatives but high heterogeneity limits specific intervention recommendations Relevant to Australian aged care quality standards and digital health initiatives, aligns with RACGP guidelines on social determinants of health Middle-aged and older adults in community and healthcare settings, particularly relevant for aged care and primary care

Abstract

BACKGROUND: Digital exclusion posed a significant challenge, especially in middle-aged and older adults, which affected their health outcomes. However, the evidence regarding the associations of digital exclusion on physical or cognitive function outcomes was controversial, and no systematic review had been performed to synthesize the pooled associations. OBJECTIVE: This study aimed to explore the relationship between digital exclusion and physical or cognitive function in middle-aged and older adults. METHODS: We conducted a systematic review and meta-analysis of cohort and cross-sectional studies, including Chinese or English publications retrieved from PubMed, Embase, Web of Science, PsycINFO, Scopus, CNKI, and Wanfang databases up to August 31, 2024. The risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS). The pooled effect size was calculated based on odds ratios (ORs), hazard ratios, risk ratios, and 95% CIs. This study was registered on PROSPERO (CRD42024585459). RESULTS: Nineteen studies met the inclusion criteria, including 13 cohort studies and 6 cross-sectional studies, which had moderate-to-low risk of bias. The pooled analysis indicated that digital exclusion had prospective associations with decreased basic activities of daily living (incidence rate ratio 1.35, 95% CI 1.12-1.64, I2=94.7%) and instrumental activities of daily living (incidence rate ratio 1.46, 95% CI 1.13-1.89, I2=96.2%), or cross-sectional association with activities of daily living (OR 1.23, 95% CI 0.41-3.73, I2=91%), with no statistical significance in the prospective association with frailty (OR 1.21, 95% CI 0.92-1.59, I2=95.2%). There were prospective associations between digital exclusion and dementia (hazard ratio 1.78, 95% CI 1.43-2.22, I2=0%), decreased Mini-Mental State Examination scores (OR 1.96, 95% CI 1.39-2.75, I2=0%), as well as cross-sectional associations with Mini-Mental State Examination scores (OR 2.90, 95% CI 2.07-4.07, I2=0%), and no statistical significance in the prospective association with cognitive impairment (risk ratio 2.08, 95% CI 0.98-4.44, I2=78.2%). CONCLUSIONS: Our findings indicated the negative associations of digital exclusion with physical and cognitive functions. Future research and clinical practice should consider designing digital interventions and services that match the physical and cognitive capacities and preferences of middle-aged and older adults, thereby improving digital engagement and reducing the harms associated with digital exclusion. Policies should focus on expanding access, reducing financial barriers, and improving digital literacy. However, due to the presence of heterogeneity and publication bias, the results should be interpreted cautiously.

References

1. 1.Yu, J., Huang, J., Zhou, S., Wan, X., Xie, Q., Zhao, Y., Yang, J., & Feng, H. (2026). The associations between digital exclusion and physical or cognitive function in middle-aged and older adults: Systematic review and meta-analysis. JMIR Aging. https://doi.org/10.2196/75920