Digital exclusion and frailty among older adults: findings from four longitudinal cohort studies

BACKGROUND: Digital exclusion has emerged as a critical determinant of health inequality among older adults. However, evidence on its association with frailty remains limited. This study aims to examine the relationships between digital exclusion and frailty. METHODS: This study used data from four prospective cohorts: the China Health and Retirement Longitudinal Study (CHARLS), the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA) and the Mexican Health and Aging Study (MHAS). Digital exclusion was recorded as an absence from Internet use by self-reported data. Frailty status was assessed by the frailty index (FI) ranging from 0 to 1, and frailty was defined as FI ≥ 0.25. Generalised estimating equations were used to assess the associations between digital exclusion and frailty outcomes, adjusting for potential confounders. Linear mixed-effect models were applied to analyse the associations of digital exclusion with frailty progression. The associations between change in digital exclusion status and frailty were also analysed. RESULTS: A total of 9091 participants from CHARLS, 13 210 from HRS, 6065 from ELSA and 9067 from MHAS were included according to the inclusion and exclusion criteria. Digital exclusion was significantly associated with higher odds of frailty across most cohort studies: CHARLS (OR = 2.90, 95% CI = 1.58-5.32), HRS (OR = 1.37, 95% CI = 1.25-1.51) and ELSA (OR = 1.33, 95% CI = 1.14-1.55). Digital exclusion was also associated with faster frailty progression in CHARLS (β = 0.007, 95% CI = 0.001-0.013) and ELSA (β = 0.007, 95% CI = 0.006-0.008). Participants transitioning from digital exclusion to digital inclusion showed significantly lower odds of frailty compared with those persistently excluded. CONCLUSIONS: A considerable proportion of older adults still experienced digital exclusion. Digital exclusion was associated with a higher likelihood of frailty and faster frailty progression among older adults. Transitions from digital exclusion to digital inclusion were linked to lower odds of frailty. These findings highlight digital exclusion as a potential correlate of frailty in later life and underscore that promoting equitable digital access and literacy may be a relevant consideration for strategies aimed at supporting healthy ageing.